Duration of Continued Disputed Services and Enrollee Responsibility Sample Clauses

Duration of Continued Disputed Services and Enrollee Responsibility. (A) If the Contractor continues the Enrollee’s disputed services, the Contractor shall continue the disputed services until one of the following occurs: (1) the Aggrieved Person, the Enrollee's legal guardian, or other authorized representative, withdraws the Appeal or State Fair Hearing request; (2) the Aggrieved Person, the Enrollee's legal guardian, or other authorized representative, fails to request a State Fair Hearing within 10 calendar days after the Contractor sends the notice of an adverse resolution; (3) the Enrollee, the Enrollee's legal guardian, or other authorized representative, fails to submit to the State Fair Hearing office, within 10 calendar days after the Contractor sends the notice of an adverse resolution, a written request for continuation of the disputed services during the State Fair Hearing; or (4) a State Fair Hearing officer issues a hearing decision adverse to the Aggrieved Person, the Enrollee's legal guardian, or other authorized representative. (B) If the final resolution of the Appeal or State Fair Hearing is adverse to the Aggrieved Person, the Enrollee's legal guardian, or other authorized representative, that is, the decision upholds the Contractor’s Adverse Benefit Determination, the Contractor or Provider may, consistent with the State’s policy on recoveries and consistent with this Contract, recover the cost of the disputed services furnished to the Enrollee while the Appeal or State Fair Hearing was pending to the extent the services were furnished solely because of the requirements found in Article 8.3.6 of this attachment and in accordance with 42 CFR § 431.230(b).
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Duration of Continued Disputed Services and Enrollee Responsibility. (A) If the Contractor continues the Enrollee’s disputed services, the Contractors shall continue the disputed services until one of the following occurs: (1) the Aggrieved Party withdraws the Appeal; (2) ten days pass after the Contractor mails written Notice of Appeal Resolution that is adverse to the Aggrieved Party and within that 10 day time period, and the Aggrieved Party does not request a State fair hearing with continuation of disputed services until a State fair hearing decision is reached; (3) a State fair hearing officer issues a hearing decision adverse to the Aggrieved Party; or (4) the time period of service limits of a previously authorized service has been met. (B) If the final resolution of the Appeal or State fair hearing is adverse to the Enrollee, that is, the decision upholds the Contractor’s Action, the Contractor may recover the cost of the disputed service furnished to the Enrollee while the Appeal or State fair hearing was pending to the extent they were furnished solely because they were furnished according to the requirements found in Article 8.4.8 of this Contract and in accordance with 42 CFR 431.230(b).
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Duration of Continued Disputed Services and Enrollee Responsibility. If the Contractor continues the Enrollee’s disputed services, the Contractors shall continue the disputed services until one of the following occurs:
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Duration of Continued Disputed Services and Enrollee Responsibility. (A) If the Contractor continues the Enrollee’s disputed services, the Contractors shall continue the disputed services until one of the following occurs: (1) the Aggrieved Person withdraws the Appeal; (2) ten days pass after the Contractor mails written Notice of Appeal Resolution that is adverse to the Enrollee and within that 10 day time period, and the Aggrieved Person does not request a State fair hearing with continuation of disputed services until a State fair hearing decision is reached; (3) a State fair hearing officer issues a hearing decision adverse to the Aggrieved Person; or (4) the time period of service limits of a previously authorized service has been met. (B) If the final resolution of the Appeal or State fair hearing is adverse to the Aggrieved Person, that is, the decision upholds the Contractor’s Adverse Benefit Determination, the Contractor or Provider may consistent with the Department’s usual policy on recoveries and consistent with this Contract, recover the cost of the disputed service furnished to the Enrollee while the Appeal or State fair hearing was pending to the extent they were furnished solely because they were furnished according to the requirements found in Article 8.4.8 of this Contract and in accordance with 42 CFR 431.230(b).
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Related to Duration of Continued Disputed Services and Enrollee Responsibility

  • Employer Responsibility The Employer accepts its responsibility to insure equal opportunity in all aspects of employment for all qualified persons regardless of race, creed, religion, color, national origin, age, disability, reliance on public assistance, sex, marital status, sexual orientation/affectional preference, or any other class or group distinction, as set forth by state or federal anti-discrimination laws, or in Board policy.

  • Provider Responsibilities The Private Child-Caring Facility (PCC) (a.k.a., Provider) must comply with the following requirements:

  • Coordination of Services Consultant agrees to work closely with City staff in the performance of Services and shall be available to City’s staff, consultants and other staff at all reasonable times.

  • Employee Responsibility Each employee is responsible for the care and maintenance of such equipment. The Company retains the right to inspect the equipment at any time and to require the employee to provide an accounting of any loss or abuse.

  • Location of Services The Purchaser’s data shall remain within the continental United States at all times and on computing and data storage devices residing therein. Contractor’s services shall be subject to the United States legal jurisdiction.

  • Acknowledgement of Services and Responsibility of the Manager The Resident acknowledges that neither the Manager nor the Institution stands in loco parentis with respect to the Resident. The Residence provides living accommodations for independent students who are to be responsible and accountable for their personal needs and their interactions with their fellow residents as opposed to residential care. The Manager is responsible for the maintenance and operation of the residence. The Manager, in consultation with the Institution, may from time to time, in its sole and unfettered discretion, establish and/or amend policies, protocols and guidelines to uphold and ensure compliance with the standards set forth by the Manager, all of which will constitute part of the Residence Community Living Standards or Institution Code of Conduct, as appropriate. The Resident hereby acknowledges and agrees that they are solely responsible for their compliance with / review of such policies, protocols and guidelines (as may be created, amended, revised or restated by the Manager) found at xxx.xxxxxxxxxxxxxxxxx.xx.

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