Page 103

97 opportunity to fully participate in the review process, whether that process is in person or in writing.

d. As required by 42 CFR 457.1140(c), all review decisions are in writing.

e. DHCS requires all participating plans to report benefits-related grievances once a year. In addition, DHCS tracks all complaints directly received from subscribers, and any publicly available information on the number and type of benefit grievances filed by subscribers enrolled in a participating plan. Grievance information is used by DHCS to identify problem areas and to take appropriate steps towards improvements.

12.3. Premium Assistance Programs- If providing coverage through a group health plan that does not meet the requirements of 42 CFR 457.1120, describe how the State will assure that applicants and enrollees have the option to obtain health benefits coverage other than through the group health plan at initial enrollment and at each redetermination of eligibility.