Current through Pa Acts 2024-53, 2024-56 through 2024-111
Section 991.2181 - Departmental powers and duties(a) The department shall require that records and documents submitted to a managed care plan or utilization review entity as part of any complaint or grievance be made available to the department, upon request, for purposes of enforcement or compliance with this article.(b) The department shall compile data received from a managed care plan on an annual basis regarding the number, type and disposition of complaints and grievances filed with a managed care plan under this article.(c) The department shall issue guidelines identifying those provisions of this article that exceed or are not included in the "Standards for the Accreditation of Managed Care Organizations" published by the National Committee for Quality Assurance. These guidelines shall be published in the Pennsylvania Bulletin and updated as necessary. Copies of the guidelines shall be made available to managed care plans, health care providers and enrollees upon request.(d) The department and the Insurance Department shall ensure compliance with this article. The appropriate department shall investigate potential violations of the article based upon information received from enrollees, health care providers and other sources in order to ensure compliance with this article.(e) The department and the Insurance Department shall promulgate such regulations as may be necessary to carry out the provisions of this article.(f) The department in cooperation with the Insurance Department shall submit an annual report to the General Assembly regarding the implementation, operation and enforcement of this article.1921, May 17, P.L. 682, No. 284, § 2181, added 1998, June 17, P.L. 464, No. 68, § 1, effective 1/1/1999.