Evidentiary standards Sample Clauses

Evidentiary standards. At a minimum, the supporting documentation must demonstrate the following to the satisfaction of both EOHHS and CMS staff with appropriate clinical or medical expertise: 2.3.3.5.1.2.1. The Enrollee is presently engaging in a pattern of disruptive conduct that is substantially impairing the Contractor’s ability to arrange for or provide Covered Services to the Enrollee and/or other Enrollees. 2.3.3.5.1.2.2. The Contractor took reasonable efforts to address the disruptive conduct including at a minimum: 2.3.3.5.1.2.2.1. A documented effort to address the Enrollee’s underlying interests and needs reflected in his/her disruptive conduct and provide reasonable accommodations as defined by the Americans with Disabilities Act including those for individuals with mental and/or cognitive conditions. An accommodation is reasonable if it is efficacious in providing equal access to services and proportional to costs. EOHHS and CMS will determine whether the reasonable accommodations offered are sufficient. 2.3.3.5.1.2.2.2. A documented provision of information to the Enrollee of his or her right to use the Contractor Grievance procedures. 2.3.3.5.1.2.3. The Contractor provided the Enrollee with a reasonable opportunity to cure his/her disruptive conduct. 2.3.3.5.1.2.4. The Contractor complied with all Enrollee notice requirements. 2.3.3.5.1.2.5. The Contractor must provide evidence that the Enrollee’s behavior is not related to the use, or lack of use, of Covered Services. 2.3.3.5.1.2.6. The Contractor may also provide evidence of other extenuating circumstances.