Common use of Agency Review Clause in Contracts

Agency Review. The agency review process begins when an applicant or participant requests a review of the care manager supervisor’s decision by the executive director of the agency or the director’s designee. The request must be made in writing to the AAA within 18 calendar days of the date of the case manager’s supervisor’s decision. The executive director or his/her designee (an employee of the AAA above the level of care manager supervisor) shall conduct the Agency Review at the applicant’s or participant’s home or at the AAA office, whichever is more convenient for the applicant or participant. The applicant or participant, his/her advocate (if desired), and the care manager or the care manager supervisor shall attend the review. Applicants and participants will be given the opportunity to testify, present supporting materials and explain why they disagree with the action or decision and what they would view as an appropriate alternative. The care manager or the care manager supervisor will also be asked to testify and explain the reasons for the decision or action taken. Within 5 business days of the meeting (and after consulting with the agency’s executive director if the person conducting the review is a designee), the person conducting the review will prepare the agency’s final decision in writing which will include facts of the case and the specific reason for the decision. The applicant or participant and his/her advocate (if any) will each be sent a copy of the decision by registered or certified mail, return receipt requested. The executive director or director’s designee shall inform the applicant or participant of his/her right to Administrative Hearing under Step 3 if dissatisfied with the agency’s final decision.

Agency Review. The agency review process begins when an applicant or participant requests a review of the care manager supervisor’s decision by the executive director of the agency or the director’s designee. The request must be made in writing to the AAA within 18 eighteen (18) calendar days of the date of the case manager’s supervisor’s decision. The executive director or his/her designee (an employee of the AAA above the level of care manager supervisor) shall conduct the Agency Review at the applicant’s or participant’s home or at the AAA office, whichever is more convenient for the applicant or participant. The applicant or participant, his/her advocate (if desired), and the care manager or the care manager supervisor shall attend the review. Applicants and participants will be given the opportunity to testify, present supporting materials and explain why they disagree with the action or decision and what they would view as an appropriate alternative. The care manager or the care manager supervisor will also be asked to testify and explain the reasons for the decision or action taken. Within 5 five (5) business days of the meeting (and after consulting with the agency’s executive director if the person conducting the review is a designee), the person conducting the review will prepare the agency’s final decision in writing which will include facts of the case and the specific reason for the decision. The applicant or participant and his/her advocate (advocate, if any) , will each be sent a copy of the decision by registered or certified mail, return receipt requested. The executive director or director’s designee shall inform the applicant or participant of his/her right to Administrative Hearing under Step 3 if dissatisfied with the agency’s final decision.