Information on Grievance. Internal Appeal, and Board of Hearing (BOH) procedures and timeframes, including: a) The right to file Grievances and Internal Appeals; b) The requirements and timeframes for filing a Grievance or Internal Appeal; c) The availability of assistance in the filing process; d) The toll-free numbers that the Enrollee can use to file a Grievance or an Internal Appeal by phone; e) The fact that, when requested by the Enrollee, MCO Covered Services will continue to be provided if the Enrollee files an Internal Appeal or a request for a BOH hearing within the timeframes specified for filing, and that the Enrollee may be required by EOHHS to pay the cost of services furnished while a BOH Appeal is pending, if the final decision is adverse to the Enrollee; f) The right to obtain a BOH hearing; g) The method for obtaining a BOH hearing; h) The rules that govern representation at the BOH hearing; and i) The right to file a grievance directly with EOHHS, how to do so, and EOHHS contact information; j) Information on advance directives in accordance with Section 5.1.E; k) Information on the access standards specified in Section 2.9.B; and l) Information on how to report suspected fraud or abuse;
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Sources: Masshealth Managed Care Organization Contract, Masshealth Managed Care Organization Contract, Managed Care Organization Contract
Information on Grievance. Internal Appeal, and Board of Hearing (BOH) procedures and timeframes, including:
a) The right to file Grievances and Internal Appeals;
b) The requirements and timeframes for filing a Grievance or Internal Appeal;
c) The availability of assistance in the filing process;
d) The toll-free numbers that the Enrollee can use to file a Grievance or an Internal Appeal by phone;
e) The fact that, when requested by the Enrollee, MCO Covered Services will continue to be provided if the Enrollee files an Internal Appeal or a request for a BOH hearing within the timeframes specified for filing, and that the Enrollee may be required by EOHHS to pay the cost of services furnished while a BOH Appeal is pending, if the final decision is adverse to the Enrollee;
f) The right to obtain a BOH hearing;
g) The method for obtaining a BOH hearing;
h) The rules that govern representation at the BOH hearing; and;
i) The right to file a grievance directly with EOHHS, how to do so, and EOHHS contact information;; and
j) Information on advance directives in accordance with Section 5.1.E;
k) Information on The availability of the access standards specified in Section 2.9.B; and
l) Information on how to report suspected fraud or abuse;ombudsman.
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