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Common use of Fair Hearing Clause in Contracts

Fair Hearing. Explain that: i) Enrollee has a right to a State Fair Hearing and Aid to Continuing in some situations. ii) Describe situations when the Enrollee may ask for a fair hearing as described in Section 25 of this Agreement including State or LDSS decision about staying in or leaving the plan; decision the Contractor makes that stops or limits Medicaid benefits; Contractor decision agreeing with doctor who will not order services (must complain to the plan first). iii) Describe how to request a fair hearing (assistance through member services, LDSS, State fair hearing contact).

Appears in 5 contracts

Samples: Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.), Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.), Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.)

Fair Hearing. Explain that: i) Enrollee has a right to a State Fair Hearing and Aid to Continuing in some situations. ii) Describe situations when the Enrollee may ask for a fair hearing as described in Section 25 of this Agreement including State or LDSS decision about staying in or leaving the plan; decision the Contractor makes that stops or limits Medicaid benefits; Contractor decision agreeing with doctor who will not order services (must complain to the plan first). iii) Describe how to request a fair hearing (assistance through member services, LDSS, State fair hearing contact).

Appears in 1 contract

Samples: Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.)

Fair Hearing. Explain that: i) Enrollee has a right to a State Fair Hearing and Aid to Continuing in some situations. ii) Describe situations when the Enrollee may ask for a fair hearing as described in Section 25 of this Agreement including State or LDSS decision about staying in or leaving the plan; decision the Contractor makes that stops or limits Medicaid FHPlus benefits; Contractor decision agreeing with doctor who will not order services (must complain to the plan first). iii) Describe how to request a fair hearing (assistance through member services, LDSS, State fair hearing contact).

Appears in 1 contract

Samples: Consultant Services Agreement (Wellcare Health Plans, Inc.)

Fair Hearing. Explain that: i) Enrollee has a right to a State Fair Hearing and Aid to Continuing in some situations. ii) Describe situations when the Enrollee may ask for a fair hearing as described in Section 25 of this Agreement including State or LDSS decision about staying in or leaving the plan; decision the Contractor makes that stops or limits Medicaid benefits; Contractor decision agreeing with doctor who will not order services (must complain to the plan first). iii) Describe how to request a fair hearing (assistance through member services, LDSS, State fair hearing contact).

Appears in 1 contract

Samples: Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.)