1368.015. (a) Effective July 1, 2003, every plan with an internet website shall provide an online form through its internet website that subscribers or enrollees can use to file with the plan a grievance, as described in Section 1368, online.
(b) The internet website shall have an easily accessible online grievance submission procedure that shall be accessible through a hyperlink on the internet website’s home page or member services portal clearly identified as “GRIEVANCE FORM.” All information submitted through this process shall be processed through a secure server.
(c) The online grievance submission process shall be approved by the Department of Managed Health Care and shall meet the following requirements:
(1) It shall utilize an online grievance form in HTML format that allows the user to enter required information directly into the form.
(2) It shall allow the subscriber or enrollee to preview the grievance that will be submitted, including the opportunity to edit the form prior to submittal.
(3) It shall include a current hyperlink to the Department of Managed Health Care internet website, and shall include a statement in a legible font that is clearly distinguishable from other content on the page and is in a legible size and type, containing the following language:
“The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your health plan, you should first telephone your health plan at (insert health plan’s telephone number) and use your health plan’s grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than 30 days, you may call the department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number (1-888-466-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department’s internet website www.dmhc.ca.gov has complaint forms, IMR application forms, and instructions online.”
The plan shall update the URL, hyperlink, and telephone numbers in this statement as necessary.
(d) A plan that utilizes a hardware system that does not have the minimum system requirements to support the software necessary to meet the requirements of this section is exempt from these requirements until January 1, 2006.
(e) For purposes of this section, the following terms shall have the following meanings:
(1) “Home page” means the first page or welcome page of an internet website that serves as a starting point for navigation of the internet website.
(2) “HTML” means Hypertext Markup Language, the authoring language used to create documents on the world wide web, which defines the structure and layout of a web document.
(3) “Hyperlink” means a special HTML code that allows text or graphics to serve as a link that, when clicked on, takes a user to another place in the same document, to another document, or to another internet website or page.
(4) “Member services portal” means the first page or welcome page of an internet website that can be reached directly by the internet website’s home page and that serves as a starting point for a navigation of member services available on the internet website.
(5) “Secure server” means an internet connection to an internet website that encrypts and decrypts transmissions, protecting them against third-party tampering and allowing for the secure transfer of data.
(6) “URL” or “Uniform Resource Locator” means the address of an internet website or the location of a resource on the world wide web that allows a browser to locate and retrieve the internet website or the resource.
(7) “Internet website” means a site or location on the world wide web.
(f) (1) Every health care service plan, except a plan that primarily serves Medi-Cal or Healthy Families Program enrollees, shall maintain an internet website. For a health care service plan that provides coverage for professional mental health services, the internet website shall include, but not be limited to, providing information to subscribers, enrollees, and providers that will assist subscribers and enrollees in accessing mental health services as well as the information described in Section 1368.016.
(2) The provision in paragraph (1) that requires compliance with Section 1368.016 shall not apply to a health care service plan that contracts with a specialized health care service plan, insurer, or other entity to cover professional mental health services for its enrollees, provided that the health care service plan provides a link on its internet website to an internet website operated by the specialized health care service plan, insurer, or other entity with which it contracts, and that plan, insurer, or other entity complies with Section 1368.016.
(Amended by Stats. 2020, Ch. 370, Sec. 194. (SB 1371) Effective January 1, 2021.)
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