Sec. 21.86.100. Complaint system; report.

231 words·~1 min read·/ak/title-21/chapter-86/21-86-100

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(a)A health maintenance organization shall establish and maintain a complaint system to provide reasonable procedures for the resolution of written complaints initiated by its enrollees. A complaint system must provide a procedure for forwarding to the commissioner of health a duplicate copy of a complaint relating to patient care or facility operation.

(b)A health maintenance organization shall annually, on or before March 1, submit to the director, in a form prescribed by the director, a report covering the preceding calendar year. The health maintenance organization shall provide a copy of this report to the commissioner of health. The report submitted under this subsection must include

(1)a description of the procedures used in its complaint system;

(2)the total number of complaints handled through its complaint system and a compilation of the causes underlying the complaints filed; and

(3)the number, amount, and disposition of malpractice claims made by an enrollee that were settled during the year by the health maintenance organization; information concerning malpractice claims shall be held confidential by the director and by the commissioner of health, and is not subject to public disclosure.

(c)The director or the commissioner of health may, at any time during normal business hours, examine the complaint system in any place of business of the health maintenance organization in order to determine compliance with this section.