"NEW SECTION.  Sec. 7   (1) Each retainer health care practice that offers a retainer agreement must have a fully operational, comprehensive grievance process that complies with the requirements of this section and any rules adopted by the commissioner to implement this section.
     (2) Each retainer health care practice must process as a complaint, a retainer subscriber's expression of dissatisfaction about customer service or the quality or availability of a primary care service. Each retainer health care practice must implement procedures for registering and responding to oral and written complaints in a timely and thorough manner.
     (3) Each retainer health care practice must provide written notice to a retainer subscriber or the retainer subscribers' designated representative of its decision to deny, modify, reduce, or terminate the retainer agreement, or provision of primary care services.
     (4) Each retainer health care practice must process as an appeal a retainer subscriber written or oral request that the retainer health care practice reconsider: (a) Its resolution of a complaint made by a retainer subscriber; or (b) its decision to deny, modify, reduce, or terminate the retainer agreement or provision of primary care services or benefits. A retainer health care practice must not require that a retainer subscriber file a complaint prior to seeking appeal of a decision under (b) of this subsection.
     (5) To process an appeal, each retainer health care practice must:
     (a) Provide written notice to the retainer subscriber when the appeal is received;
     (b) Assist the retainer subscriber with the appeal process;
     (c) Make its decision regarding the appeal within thirty days of the date the appeal is received. An appeal must be expedited if the retainer subscriber reasonably determines that following the appeal process response timelines could seriously jeopardize the enrollee's life, health, or ability to regain maximum function. The decision regarding an expedited appeal must be made within seventy-two hours of the date the appeal is received;
     (d) Cooperate with a representative authorized in writing by the retainer subscriber;
     (e) Consider information submitted by the retainer subscriber;
     (f) Investigate and resolve the appeal; and
     (g) Provide written notice of its resolution of the appeal to the retainer subscriber. The written notice must explain the retainer health care practice's decision and the supporting coverage or clinical reasons, and the retainer subscriber's right to request independent review of the retainer health care practice's decision.
     (6) Written notice required by subsection (3) of this section must explain:
     (a) The retainer health care practice's decision and the supporting coverage or clinical reasons; and
     (b) The retainer health care practice's appeal process, including information, as appropriate, about how to exercise the retainer subscriber's rights to obtain a second opinion, and how to continue receiving primary care services as provided in this section.
     (7) When a retainer subscriber requests that the retainer health care practice reconsider its decision to modify, reduce, or terminate an otherwise primary care health service that a retainer subscriber is receiving through the retainer agreement and the retainer health care practice's decision is based upon a finding that the primary care service, or level of health service, is no longer medically necessary or appropriate, the retainer health care practice must continue to provide that primary care service until the appeal is resolved.
     (8) Each retainer health care practice must provide a clear explanation of the grievance process upon request, upon enrollment to new retainer subscribers, and annually to retainer subscribers.
     (9) Each retainer health care practice must ensure that the grievance process is accessible to retainer subscribers who are limited English speakers, who have literacy problems, or who have physical or mental disabilities that impede their ability to file a grievance.
     (10) Each retainer health care practice must: (a) Track each appeal until final resolution; (b) maintain, and make accessible to the commissioner for a period of three years, a log of all appeals; and (c) identify and evaluate trends in appeals."