Grievance Resolution for Covered California Expectation Sample Clauses

Grievance Resolution for Covered California Expectation. 95% of enrollee grievances resolved within 30 calendar days. 6.25% of total performance penalty at risk. Performance Level: <95% resolved within 30 calendar days: 6.25% performance penalty. 95% or greater resolved within 30 calendar days: no penalty. 95% or greater resolved within 15 calendar days: 6.25% performance credit Covered California – Final Health Plan Contract Attachments, May 620117, 2013 Attachment 14-11 Covered California – Final Health Plan Contract Attachments, May 620117, 2013 Attachment 14-12 Appendix 1 to Attachment 14. Quality, Network Management and Delivery Systems Standards Covered California Performance Requirements 2.13.1 Quality and Network Management – Quality Reporting System (QRS) - Getting the Right Care- HEDIS/CAHPS Clinical Effectiveness measure set summary Expectation: Getting the Right Care - HEDIS/CAHPS Clinical Effectiveness measure set summary (product type reporting) - 10% of total performance requirement expected. Appropriate Testing for Children With Pharyngitis Appropriate Treatment for Children With Upper Respiratory Infection Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis Use of Imaging Studies for Low Back Pain All-Cause Readmissions Annual Monitoring for Patients with Persistent Medications Plan All-Cause Readmission (average adjusted probability of readmission) CDC: Medical Attention for Nephropathy CDC: Hemoglobin-A1c Testing CDC: LDL-C Screening CDC: Eye Exam (Retinal) Performed CDC: LCL-C Control (<100 mg/DI) CDC: HbA1c Control (<8.0%) CDC: Blood Pressure Control (140/90 mm Hg) CDC: HbA1c Poorly Control (>9.0%) Controlling High Blood Pressure Cholesterol Management for Patients with Cardiovascular Conditions: LDL-C Control (<100 mg/dL) Cholesterol Management for Patients With Cardiovascular Conditions (LDL-C Screening Only) Persistence of beta blocker treatment after a heart attack Antidepressant Medication Management (Both Rates) Follow-Up After Hospitalization for Mental Illness (7-Day Rate Only) Follow-Up for Children Prescribed ADHD Medication (Both Rates) Initiation & Engagement of Alcohol & Other Drug Dependence Treatment - Engagement (13-17 Yrs and 18+ Yrs) Medication Management for People With Asthma (50%/75% remained on controller medications) Use of Spirometry Testing in the Assessment and Diagnosis of COPD Drug Therapy for Rheumatoid Arthritis Pharmacotherapy management of COPD Exacerbation (bronchodilator and systemic corticosteroid) Global Rating of Care (CAHPS) Global Rating o...
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Grievance Resolution for Covered California Expectation. 95% of enrollee grievances resolved within 30 calendar days. 6.25% of total performance penalty at risk. Performance Level: <95% resolved within 30 calendar days: 6.25% performance penalty. 95% or greater resolved within 30 calendar days: no penalty. 95% or greater resolved within 15 calendar days: 6.25% performance credit 3.1 Quality Reporting System (QRS) - Getting the Right Care- HEDIS/CAHPS Clinical Effectiveness measure set summary Diabetes Care Cardiovascular Care Behavioral Health Care Other Chronic Care

Related to Grievance Resolution for Covered California Expectation

  • Policy Grievance – Union Grievance The Union may institute a grievance alleging a general misinterpretation or violation of this Agreement by the Employer by submitting a written grievance at Step No. 1 within twenty (20) days after the circumstances have occurred. This section shall not apply to disciplinary grievances or application of competitive clauses under this Agreement.

  • Deviation from Grievance Procedure The Employer agrees that, after a grievance has been discussed at Step 2 of the grievance procedure the Employer or his representatives shall not initiate any discussion or negotiations with respect to the grievance, either directly or indirectly with the aggrieved employee without the consent of the xxxxxxx or the Union.

  • Formal Grievance Step 1 6

  • Formal Grievance Procedure 1. In the event that a complaint cannot be resolved informally, the parties shall pursue the first step in the formal grievance procedure before making any application for arbitration, unless the College and the AAUP agree in writing to alter the procedure or waive one or more of the steps by proceeding directly to arbitration. 2. Upon written request of the AAUP Contract Compliance Officer, the College shall submit any requested documents in its possession which may be necessary for investigation of the grievance. The College shall deliver such documents as soon as is reasonably possible, but no later than seven (7) days after receipt of a written request. 3. Internal Steps in the Procedure a. Step One: The Director of Human Resources (1) Within thirty (30) days of when the AAUP learns of, or in the exercise of reasonable diligence should have learned of, an alleged violation of the provisions of this Agreement, the AAUP shall submit to the Director of Human Resources a completed Faculty Grievance Form or a dated, signed, written description of the grievance, clearly labeled "grievance" containing substantially the same information as provided for on the Faculty Grievance Form. (2) Within eight (8) days of receipt of the written grievance, the Director of Human Resources shall convene a meeting to discuss the grievance. Such meeting shall include the grievant(s) and/or the designated representative(s) of the AAUP and shall be scheduled at a time which is mutually convenient to the parties. (3) The Director of Human Resources shall attempt to determine the facts pertaining to the grievance and shall notify the grievant and the AAUP in writing of his/her decision within eight (8) days in a Grievance Disposition Form or in a document containing substantially the same information as contained in a Grievance Disposition Form, which shall include written details of the reasons which support the decision. (4) Within eight (8) days after receipt of the disposition of the Director of Human Resources, the AAUP may appeal the decision in writing to the College Grievance Officer, by submitting a Grievance Disposition Reaction Form or a document containing substantially the same information as contained in a Grievance Disposition Reaction Form. (5) By agreement, the parties may decide to advance the grievance to step two of the procedure, or to appeal directly to arbitration at step D(4) of this article.

  • Informal Grievance Procedure Employees are encouraged to act promptly to attempt to resolve disputes with their manager/supervisor through an informal procedure. A meeting between the manager/supervisor and the employee should take place whenever requested by either party to assist, to clarify or resolve the grievance. The employee may be accompanied by his/her Union representative at the informal meeting. Any resolution reached at the informal step must be in accordance with the provisions of this agreement, or other rule or ordinance and shall not set precedent.

  • Policy Grievance Where either Party disputes the general application, interpretation or alleged violation of an article of this Agreement, the dispute shall be discussed initially with the Employer or the Union, as the case may be, within thirty (30) days of the occurrence. Where no satisfactory agreement is reached, either Party may submit the dispute to arbitration, as set out in Article 10.

  • GRIEVANCE PROCEDURE & ARBITRATION 6.1 In this Article a grievance shall consist only of a dispute concerning the interpretation and application of any clause in this Agreement, alleged violations of the Agreement, and alleged abuses of discretion by supervision in the treatment of employees. If any question arises as to whether a particular dispute is, or is not a grievance, within the meaning of these provisions, the question may be taken up through the Grievance Procedure and determined if necessary, by Arbitration. There shall be an xxxxxxx effort on the part of both parties, to settle such grievance promptly, through the following steps: (a) By conference between the aggrieved employee, Xxxxxxx and Xxxxxxx. Such conference to be held within five (5) working days (Saturdays, Sundays and General Holidays excluded) and the Xxxxxxx shall give his answer within five (5) working days (Saturdays, Sundays and General Holidays excluded) of the presentation of the grievance to him/her. (b) Failing settlement as in (a) by the Xxxxxxx and the Xxxxxxx, the Xxxxxxx may ask the Xxxxxxx to make an appointment with the Manager in an effort to reach a settlement. It shall be the responsibility of the Xxxxxxx and the Xxxxxxx to submit a written report to the Manager. (c) If a grievance is not settled after making every endeavour in procedures outlined in (a) and (b), it shall be referred to the General Manager. (d) Should the parties fail to reach satisfactory settlement in the preceding steps, the final settlement of the grievance must be submitted to a Board of Arbitration as outlined below. In the event that the Company has a grievance, the Manager or General Manager shall endeavour to settle the matter with the Xxxxxxx and in the event of failure, shall deal with an official of the Union. Before submitting the grievance to arbitration, the dispute may, by mutual agreement, be brought to the attention of a Joint Grievance Committee, established for his purpose by the Company and by the Local Unions. The Joint Grievance Committee will render a decision unless it is deadlocked which shall be final and binding and have the same judicial powers as a Board of Arbitration established under the following provisions. The Joint Grievance Committee shall be comprised of two (2) persons, one (1) of whom shall be selected from Management and one (1) from the Local Unions. It is understood that in the selection of the representatives the Company must name a representative from another Company must name a representative from another Company and the Union must name a representative from another Local Union. It is further agreed that in the event that any Joint Grievance Committee is unable to render a majority decision, the grieving party must within fourteen (14) calendar days of the date the Joint Grievance Committee declares a dead-lock, unless they wish to withdraw the grievance, proceed to Arbitration as outlined in Article 6, section 6.2.

  • GRIEVANCE ARBITRATION Notwithstanding any other provision of this Agreement, for the purposes of this Article, an Employee has the right to grieve any filling of a vacancy or Assignment in the bargaining unit.

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