Reporting Requirements

(1) Each RBPO or ACO shall provide the following information to the Office of Patient Protection no later than April 1st of each year. Such information shall be submitted in a manner specified by the Office of Patient Protection or using a template or form developed by the Office of Patient Protection. (a) A copy of the Patient notice used by the RBPO or ACO. (b) A summary report of the Patient appeals received by the RBPO or ACO. Summary reports shall not include any information identifying Patients, but shall include the number of appeals and the resolutions of such appeals. Appeals shall be classified into the following categories of denials, restrictions or limitations: 1. Referrals to Providers not affiliated with the RBPO or ACO. 2. Type or intensity of treatment or services. 3. Denials or restrictions on timely access to treatment or services. 4. Other. For appeals categorized as “other”, the RBPO or ACO shall include a brief description of the Patient’s concern. (c) A description of the RBPO’s or ACO’s appeals process to resolve Patient appeals, including the title and clinical background of the Internal Reviewer(s); (d) A description or example of a written resolution of an appeal upholding the RBPO or ACO decision and a description or example of a written resolution of an appeal overturning the RBPO or ACO decision. (e) The name, telephone number and email address of the person or persons within the RBPO or ACO who will serve as the general contact for the Office of Patient Protection for internal appeals and external reviews. If this contact information changes, the RBPO or ACO shall provide the new information in writing to the Office of Patient Protection within ten business days following the change. (2) If a Patient concern is resolved at the point of care or service, either with clinical or administrative staff, then the RBPO or ACO is not required to report that concern as an internal appeal.