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 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 of Personal Doctor (CAHPS) Global Rating of Specialist (CAHPS) *certain CAHPS measures may not be available for all Product Types
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

  • Letter of Understanding Grievance Commissioner System This is to confirm the discussion of the parties during collective bargaining that they are committed to encouraging early discussion and resolution of labour relations issues at the local level and seek to resolve grievances in a timely and cost-efficient manner. To that end, this is to confirm that pursuant to Article 8, the parties agree that the Employer and Union at individual Homes may agree to utilize the following process in order to resolve a particular grievance through the utilization of a joint mediation-arbitration procedure:

  • 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.

  • Statement of Grievance The grievance shall contain a statement of: (a) The specific situation, act or acts complained of as an agreement violation; (b) The inequity or damage suffered by the employee; and (c) The relief sought.

  • Grievance Commissioner System This is to confirm the discussion of the parties during collective bargaining that they are committed to encouraging early discussion and resolution of labour relations issues at the local level and seek to resolve grievances in a timely and cost efficient manner. To that end, this is to confirm that pursuant to Article 8, the parties agree that the Employer and Union at individual nursing homes may agree to utilize the following process in order to resolve a particular grievance through the utilization of a joint mediation-arbitration procedure:

  • 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 36.01 A grievance is defined as any difference or dispute arising between the Union and the Company relating to the interpretation, application, administration or alleged violation of the Agreement, including any question as to whether a matter is arbitrable. 36.02 There are three types of grievances under this Collective Agreement: (a) An Individual Grievance, which is an unresolved complaint of an individual employee wherein he or she believes that the Collective Agreement has been improperly interpreted, applied or administered to his or her detriment. An Individual Grievance may be submitted at Step 1 of the grievance procedure following the attempt to try to resolve the matter as per 36.04. (b) A Group Grievance, which is an unresolved complaint of a group of employees wherein they believe that the Collective Agreement has been improperly interpreted, applied or administered to their collective detriment. A group grievance may be submitted at Step 1 of the grievance procedure within ten (10) days of when the employees became or ought reasonably to have become aware that the circumstances giving rise to the grievance occurred. (c) A Policy Grievance which is an unresolved issue arising between the Union and the Employer around the interpretation, application or administration of the Collective Agreement but does not include matters which could be pursued either as an Individual or Group Grievance. A policy grievance may be submitted by the Union or the Employer at Step 2 of the grievance procedure within ten (10) days of when the party became or ought reasonably to have become aware that the circumstances giving rise to the grievance occurred. 36.03 For the purpose of this Article, reference to "days" relating to Steps in the grievance and arbitration procedure shall mean calendar days. 36.04 Employees who have a complaint shall first take the matter up with their Supervisor/Manager within five (5) days when the cause of the complainant occurred or ought to have reasonably come to the attention of the employee. The employee may be accompanied by a Xxxxxxx and the Xxxxxxx may also discuss the matter with the Supervisor/Manager before the grievance is committed to writing. If the matter is not resolved within five (5) days of it first being raised or if the decision of the Supervisor/Manager is not satisfactory to the Xxxxxxx, the Xxxxxxx/Committee Person may appeal the decision by filing a grievance. The grievance will be committed to writing and delivered to the Manager, Supervisor or the Human Resources department within five (5) days after the Xxxxxxx has received the decision. Following the issuance of the grievance, proceed to Step One (1). 36.05 Grievances may also arise from the issuance of a corrective action by the Employer. An employee that is given a corrective action and feels that the subject matter or the punishment resulting from the corrective action is inappropriate may file a grievance within five (5) days after the Xxxxxxx has received the decision. Grievances will be committed to writing and delivered to the Manager, Supervisor or Human Resources department. Following the issuance of the grievance, proceed to Step One (1).