Unified Appeals and Grievance Process. Health Plan’s Exclusively Aligned HIDE D-SNP shall implement a unified grievance and appeal system and process grievances and appeals in compliance with the terms of 42 CFR §§ 422.629 – 634, 438.210, 438.400 & 438.402. This requirement includes: • Grievances and appeals systems that meet the standards described in 42 CFR § 422.629; • An integrated grievance process that complies with 42 CFR § 422.630; • A process for making integrated organization determinations consistent with 42 CFR § 422.631; • Continuation of benefits while an integrated reconsideration is pending consistent with 42 CFR § 422.632; • A process for making integrated reconsiderations consistent with 42 CFR § 422.633; and A process for effectuation of decisions consistent with 42 CFR § 422.634. Implement a process to ensure that enrollees are provided reasonable assistance in completing forms and taking other procedural steps related to integrated appeals and grievances. This includes, but is not limited to, auxiliary aids and services upon request, such as providing interpreter services and toll-free numbers that have adequate TTY/TTD and interpreter capability.
