Grievance Administration. Internal (plan level) Grievance An Enrollee may file an Internal Enrollee Grievance at any time with the One Care Plan or its providers by calling or writing to the Contractor or provider. The Contractor must have a system in place for addressing Enrollee Grievances, including Grievances regarding reasonable accommodations and access to services under the Americans with Disabilities Act. The Contractor must maintain written records of all Grievance activities, and notify CMS and EOHHS of all internal Grievances. The system must meet the following standards: Timely acknowledgement of receipt of each Enrollee Grievance; Timely review of each Enrollee Grievance; Response, electronically, orally or in writing, to each Enrollee Grievance within a reasonable time, but no later than thirty (30) days after the Contractor receives the Grievance; The Contractor may extend the thirty (30) day timeframe for processing a Grievance by up to fourteen (14) calendar days if the Enrollee requests the extension or if the Contractor shows there is a need for additional information and how the delay is in the interest of the Enrollee. If the Contractor extends the timeframe for a Grievance and it is not at the Enrollee’s request, the Contractor must make reasonable efforts to give the Enrollee prompt oral Notice of the delay. In addition, within two (2) days the Contractor must give the Enrollee written Notice of the reason for the extended timeframe and inform the Enrollee of the right to file a Grievance if he or she disagrees with that decision. Expedited response, orally or in writing, within twenty‑four (24) hours after the Contractor receives the Grievance to each Enrollee Grievance whenever Contractor extends the Appeals timeframe or Contractor refuses to grant a request for an expedited Appeal; Provides notice to the Enrollee of the disposition of the Grievance meets the requirements of 42 C.F.R § 438.10 and: Be produced in a manner, format, and language that can be easily understood; Be made available in Prevalent Languages, upon request; and Include information, in the most commonly used languages about how to request translation services and Alternative Formats; and The availability to Enrollees of information about Enrollee Grievances and Appeals, as described here and in Section 2.12, including reasonable assistance in completing any forms or other procedural steps, which shall include interpreter services and toll‑free numbers with TTY/TDD and interpreter capabil...
Grievance Administration. Internal (plan level) Grievance An Enrollee may file an Internal Enrollee Grievance at any time with the ICO or its providers by calling or writing to the Contractor or provider. The Contractor must have a system in place for addressing Enrollee Grievances, including Grievances regarding reasonable accommodations and access to services under the Americans with Disabilities Act. The Contractor must maintain written records of all Grievance activities, and notify CMS and MassHealth of all internal Grievances. The system must meet the following standards: Timely acknowledgement of receipt of each Enrollee Grievance; Timely review of each Enrollee Grievance; Response, electronically, orally or in writing, to each Enrollee Grievance within a reasonable time, but no later than 30 days after the Contractor receives the Grievance; Expedited response, orally or in writing, within 24 hours after the Contractor receives the Grievance to each Enrollee Grievance whenever Contractor extends the Appeals timeframe or Contractor refuses to grant a request for an expedited Appeal; and Availability to Enrollees of information about Enrollee Appeals, as described in Section 2.12, including reasonable assistance in completing any forms or other procedural steps, which shall include interpreter services and toll-free numbers with TTY/TDD and interpreter capability. External Grievance The Contractor shall inform Enrollees that they may file an external Grievance through 1-800 Medicare. The Contractor must display a link to the electronic Grievance form on the Xxxxxxxx.xxx Internet Web site on the Contractor’s main Web page. 422.504(b)(15)(ii). The Contractor must inform Enrollees of the email address, postal address or toll-free telephone number where an Enrollee Grievance may be filed. External Grievances filed with MassHealth shall be forwarded to the Contract Management Team and entered into the CMS Complaints tracking module, which will be accessible to the Contractor.
Grievance Administration. 2.13.2.1. Internal (plan level) Grievance
Grievance Administration. 2.11.4.1.Grievances Filed with the STAR+PLUS MMP or their Providers
Grievance Administration. Time spent in processing or representing grievances but only to the extent authorized in Section G. of Article 9,
Grievance Administration. The central parties agree to develop a pilot project to assist the local parties with innovative and creative solutions to enhance grievance administration, such project could include regional review of grievances, regional mediation and/or regional panels of arbitrators. The parties will canvass their respective parties to elicit interest in participation in the project. Letter of Understanding Re: Best Practices The central parties agree to develop communication and promotionalstrategies regarding the best practices for professional development including identifying success stories; writing articles; and application. To accomplish this objective, informationwill be acquired through a survey of practices of the Hospitals. The parties agree that from time to time they will endorse best practices that demonstrate creative joint quality of initiatives.
Grievance Administration. The CICO must have a formally structured Grievance system, consistent with 42 C.F.R. § 438 Subpart F, and the SCDHHS Managed Care Policies and Procedures Guide (xxxxx://xxx.xxxxxx.xxx/managedcare/site-page/mco-contract-pp), in place for addressing Enrollee Grievances, including Grievances regarding reasonable accommodations and access to services under the ADA. The CICO Grievance procedures must meet the following standards: Timely acknowledgement of receipt of each Enrollee Grievance;
Grievance Administration. Pension. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Grievance Administration
