Common use of Beneficiary Problem Resolution Processes Clause in Contracts

Beneficiary Problem Resolution Processes. The Contractor shall comply with the beneficiary problem resolution process which includes the following: a. The beneficiary’s right to a State Fair Hearing, how to obtain a hearing and the representation rules at the hearing. b. The beneficiary’s right to file grievances and appeals and the requirements and timeframes for filing. c. The beneficiary’s right to give written consent to allow a provider, acting on behalf of the beneficiary, to file an appeal. d. The beneficiary may file a grievance either orally or in writing and, as determined by DHCS, either with the DHCS or with the County. e. The availability of assistance with filing grievances and appeals. f. Provide beneficiaries with the available toll-free numbers to file oral grievances and appeals. g. The beneficiary’s right to request continuation of benefits during an appeal or State fair hearing filing although the beneficiary may be liable for the cost of any continued benefits if the action is upheld. h. Any State determined provider’s appeal rights to challenge the failure of the Provider to cover a service. i. Pursuant to 438 Subpart F, the Contractor must post notices explaining grievance, appeal, and expedited appeal process procedures in locations at all Provider sites. Notices shall be sufficient to ensure that the information is readily available to both beneficiaries and provider staff. j. Pursuant to 42 CFR 438.10, making available forms that may be used to file grievances, appeals, and expedited appeals and self-addressed envelopes that beneficiaries can access at all Contract provider sites without having to make a verbal or written request to anyone. k. A beneficiary shall not be subject to discrimination or any other penalty for filing a grievance, appeal, or expedited appeal. l. Pursuant to 438.240 related to record keeping and review requirements, identify in its grievance, appeal, and expedited appeal documentation, the roles and responsibilities of the County, the provider, and the beneficiary. m. Pursuant to 42 CFR 438.410(b), ensure that punitive action is not taken against a beneficiary or a provider because they request an expedited appeal or support a beneficiary’s request for an expedited appeal. n. Provider shall provide the client/beneficiary with a Notice of Adverse Benefits Determination (NOABD) as set forth in the County’s governing beneficiary protections policy and procedures.

Beneficiary Problem Resolution Processes. The Contractor shall comply with the beneficiary problem resolution process which includes the following: a. The beneficiary’s right to a State Fair Hearing, how to obtain a hearing and the representation rules at the hearing. b. The beneficiary’s right to file grievances and appeals and the requirements and timeframes for filing. c. The beneficiary’s right to give written consent to allow a provider, acting on behalf of the beneficiary, to file an appeal. d. The beneficiary may file a grievance either orally or in writing and, as determined by DHCS, either with the DHCS or with the County. e. The availability of assistance with filing grievances and appeals. f. Provide beneficiaries with the available toll-free numbers to file oral grievances and appeals. g. The beneficiary’s right to request continuation of benefits during an appeal or State fair hearing filing although the beneficiary may be liable for the cost of any continued benefits if the action is upheld. h. Any State determined provider’s appeal rights to challenge the failure of the Provider to cover a service. i. Pursuant to 438 Subpart F, the Contractor must post notices explaining grievance, appeal, and expedited appeal process procedures in locations at all Provider sites. Notices shall be sufficient to ensure that the information is readily available to both beneficiaries and provider staff. j. Pursuant to 42 CFR 438.10, making available forms that may be used to file grievances, appeals, and expedited appeals and self-addressed envelopes that beneficiaries can access at all Contract provider sites without having to make a verbal or written request to anyone. k. A beneficiary shall not be subject to discrimination or any other penalty for filing a grievance, appeal, or expedited appeal. l. Pursuant to 438.240 related to record keeping and review requirements, identify in its grievance, appeal, and expedited appeal documentation, the roles and responsibilities of the County, the provider, and the beneficiary. m. Pursuant to 42 CFR 438.410(b), ensure that punitive action is not taken against a beneficiary or a provider because they request an expedited appeal or support a beneficiary’s request for an expedited appeal. n. Provider shall provide the client/beneficiary with a Notice of Adverse Benefits Determination (NOABDDetermination(NOABD) as set forth in the County’s governing beneficiary protections policy and procedures.