25.5-4-107. Retaliation definition

25.5-4-107. Retaliation definition. (1) For purposes of any rules promulgated by the state department or state board and any action taken by the state department against any person, "retaliation" means taking any of the following actions against a member or someone acting on behalf of a member after the member or someone acting on behalf of the member files a complaint concerning services provided or not provided to the member:

(a) Indicating to a member that the member cannot have an advocate, family member, or other authorized representative assist the member; or

(b) (I) An adverse action that negatively affects a member's level of eligibility for or receipt of services received at the time of the complaint without verification of a change in the member's income, resources, or health-care needs that justifies the adverse action.

(II) An adverse action must not be taken against a member after a complaint has been filed until the member is notified of the proposed action, informed of the reason for the proposed action, and provided an opportunity to appeal the proposed action.

(2) "Retaliation" does not include instances when a member is not eligible for a service or program or when a provider documents a problem with a member and shares the documentation with the member or a third party prior to the member filing a complaint.