Indiana § 27-13-10-12 Approval of grievance and appeals procedures

Indiana Statutes

§ 27-13-10-12 — Approval of grievance and appeals procedures

Indiana·Title 27 INSURANCE·Art. 13 HEALTH MAINTENANCE ORGANIZATIONS·Ch. 10 Grievance Procedures

(a)Notwithstanding IC 27-13, the department shall approve the grievance and appeals procedures of a health maintenance organization if:

(1)the health maintenance organization certifies in writing to the department of the health maintenance organization's compliance with grievance and appeals procedures established by the federal Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services; and

(2)the department certifies that the grievance and appeals procedures established by the federal Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services are substantially similar to the grievance and appeals process in IC 27-13.

(b)Subsection (a) does not:

(1)limit the authority of the department;

(2)limi

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(a) Notwithstanding IC 27-13, the
department shall approve the grievance and appeals procedures of a
health maintenance organization if:
(1) the health maintenance organization certifies in writing to the
department of the health maintenance organization's compliance
with grievance and appeals procedures established by the federal
Centers for Medicare and Medicaid Services of the United States
Department of Health and Human Services; and
(2) the department certifies that the grievance and appeals
procedures established by the federal Centers for Medicare and
Medicaid Services of the United States Department of Health and
Human Services are substantially similar to the grievance and
appeals process in IC 27-13.
(b) Subsection (a) does not:
(1) limit the authority of the department;
(2) limit the responsibility of a health maintenance organization;
(3) release a health maintenance organization from the
prohibitions established under section 11 of this chapter; or
(4) require a health maintenance organization to use a grievance
and appeals procedure established by the federal Centers for
Medicare and Medicaid Services of the United States Department
of Health and Human Services.

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