Title 33, Chapter 20A, Section 35
( 33-20A-35)
(a) In the event that the outcome of the grievance procedure under Code Section 33-20A-5 is adverse to the eligible enrollee, the managed care entity shall include with the written notice of the outcome of the grievance procedure a statement specifying that any request for independent review must be made to the planning agency on forms developed by the planning agency, and such forms shall be included with the notification. Such statement shall be in simple, clear language in boldface type which is larger and bolder than any other typeface which is in the notice and in at least 14 point typeface. (b) An eligible enrollee must submit the written request for
independent review to the planning agency. Instructions on how to
request independent review shall be given to all eligible enrollees
with the written notice required under this Code section together
with instructions in simple, clear language as to what information,
documentation, and procedure are required for independent review. (c) Upon receipt of a completed form requesting independent review
as required by subsection (a) of this Code section, the planning
agency shall notify the eligible enrollee of receipt and assign the
request to an independent review organization on a rotating basis
according to the date the request is received. (d) Upon assigning a request for independent review to an
independent review organization, the planning agency shall provide
written notification of the name and address of the assigned
organization to both the requesting eligible enrollee and the
managed care entity. (e) No managed care entity may be certified by the Commissioner
under Article 1 of this chapter unless the entity agrees to pay the
costs of independent review to the independent review organization
assigned by the planning agency to conduct each review involving
such entity's eligible enrollees. |