Section 15. Other Related Coordinated Service Contractor (Csc) Processes

A. Information about grievance system to providers and subcontractors: The CSC shall provide information specified in 42 CFR438.10(g) (1) about the grievance system to all providers and subcontractors at the time that they enter into a contract. B. Grievance or appeal files: (1) All grievance or appeal files shall be maintained in a secure and designated area and accessible to HCA, upon request, for review. Grievance or appeal files shall be retained for six years following the final decision by the CSC, HCA, and administrative law judge, judicial appeal, or closure of a file, whichever occurs later. (2) The CSC shall have procedures for assuring that files contain sufficient information to identify the grievance or appeal, the date it was received, the nature of the grievance or appeal, notice to the recipient of receipt of the grievance or appeal, all correspondence between the CSC and the recipient, the date the grievance or appeal is resolved, the resolution, the notices of final decision to the recipient, and all other pertinent information. (3) Documentation regarding the grievance shall be made available to the grievant, legal guardian representative, or provider acting on behalf of the recipient if requested. [8.349.2.15 NMAC - Rp 8.349.2.15 NMAC, 7/1/2024] 8.349.2.16 COORDINATED SERVICE CONTRACTOR (CSC) PROVIDER GRIEVANCE PROCESS: The CSC shall establish and maintain written policies and procedures for the filing of provider grievances. A provider shall have the right to file a grievance with the CSC regarding utilization management decisions or provider payment issues. Grievances shall be resolved within 30 calendar days. A provider may not file a grievance on behalf of a recipient without written designation by the recipient as the recipient's representative. See 8.349.2.14 NMAC for special rules for certain expedited service authorizations.