Grievance System. During the term of this Agreement, County shall establish and operate a system through which Clients receiving Services, and the Clients’ parents or guardians, may present grievances about the delivery of the Services. At the time arrangements are made for delivery of Services to a particular Client, County shall advise the Client and the parents or guardian of the Client of the existence of this grievance system. County shall notify OYA of all unresolved grievances.
Grievance System. Client complaints received by ChildNet concerning services rendered by Network Provider shall be resolved in accordance with ChildNet’s Client grievance policies and procedures, Grievances and Appeals, CN 004.020, located on ChildNet’s website at xxxx://xxx.xxxxxxxx.xx/portal/374. Network Provider shall submit the information necessary for ChildNet to resolve Client grievances. Network Provider shall also attend hearings and otherwise cooperate with ChildNet in the resolution of Client complaints. If a complaint is made by or on behalf of a Client directly to Network Provider in connection with Network Provider’s provision of services under this Subcontract, Network Provider shall notify ChildNet which will handle the complaint in accordance with this section.
Grievance System a. Contractor shall have a Grievance System, supported with written procedures, for Members that includes a Grievance process, Appeal process and access to Contested Case Hearings. Contractor’s Grievance System shall meet the requirements of Exhibit I, OAR 410-141-3260 through 410-141-3264, and 42 CFR 438.402 through 438.414. The Grievance System must include Grievances and Appeals related to requests for accommodation in communication or provision of services for Members with a disability or limited English proficiency. OHA will review the Contractor’s procedures for compliance and notify Contractor when approved. Upon any change to the approved procedures, Contractor shall submit the changes to OHA Contract Administration Unit for approval. Contractor shall review its Grievance System policies annually and submit as follows:
(1) To the OHA Contract Administration Unit annually no later than January 31st.
(2) To the OHA Contract Administration Unit upon any significant changes, prior to formal adoption of the policy. OHA will notify Contractor within 30 days of the compliance status of the policy.
(3) To the OHA Contract Administration Unit anytime upon OHA request. OHA will notify Contractor within 30 days of the compliance status of the policy.
b. Contractor shall provide to all Providers and Subcontractors, at the time they enter into a subcontract, the following Grievance, Appeal and Contested Case Hearing procedures and timeframes:
(1) The Member’s right to a Contested Case Hearing, how to obtain a hearing and representation rules at a hearing;
(2) The Member’s right to file Grievances and Appeals and their requirements and timeframes for filing;
(3) The availability of assistance in filing;
(4) The toll-free numbers to file oral Grievances and Appeals;
(5) The Member’s right to request continuation of benefits during an Appeal or Contested Case Hearing filing and, if the Contractor’s Action is upheld in a Contested Case Hearing, the Member may be liable for the cost of any continued benefits; and
(6) Any State-determined Provider appeal rights to challenge the failure of the organization to cover a service.
Grievance System a) The Contractor shall ensure that its Grievance System includes methods for prompt internal adjudication of Enrollee Complaints, Complaint Appeals and Action Appeals and provides for the maintenance of a written record of all Complaints, Complaint Appeals and Action Appeals received and reviewed and their disposition, as specified in Appendix F of this Agreement.
b) The Contractor shall ensure that persons with authority to require corrective action participate in the Grievance System.
Grievance System. Company will provide Provider with information regarding Company’s grievance system that complies with state and federal laws, including 42 C.F.R. § 438, Subpart F. Provider agrees to adhere to the requirements of Company’s grievance and appeals procedures. Provider shall comply with Company’s Policies for grievance and appeal procedures as well as facilitate Member grievance and appeals and assist Members as required. No punitive action will be taken against any provider who files on behalf of a Member.
Grievance System. Contractor shall have a formally structured Grievance system that is compliant with Sections 45 of the Managed Care Reform and Patient Rights Act, 215 ILCS 134, and 42 C.F.R. Parts 431 Subpart E and 438 Subpart F to handle all Grievances and Appeals subject to the provisions of such sections of the Act and regulations.
Grievance System. The Contractor shall have in place a written grievance system process for subcontractors, enrollees and non- contracted providers, which define their rights regarding disputed matters with the Contractor. The Contractor’s grievance system for members includes a grievance process (the procedures for addressing member grievances), an appeals process and access to the State’s fair hearing process as outlined in Attachment F1, Enrollee Grievance System Standards. The Contractor’s dispute process for subcontractors and non-contracted providers includes a claim dispute process and access to the State’s fair hearing process as outlined in Attachment F2, Provider Claim Dispute Standards. The Contractor shall remain responsible for compliance with all requirements set forth in Attachments F1, Enrollee Grievance System Standards, F2, Provider Claim Dispute Standards, and 42 CFR Part 438 Subpart F.
Grievance System. 35.5.7.1 The Contractor shall comply with all duties and/or obligations incurred under the Contract during the Transition Period, with respect to the Grievance System process established in Article 14 of the Contract.
Grievance System. Health Plan and/or Subcontractor shall provide Provider information specified in 42 CFR 438.10(g)(2)(xi) about Health Plan’s and/or Subcontractor’s grievance system at the time Health Plan, Subcontractor, and Provider enter into the Agreement.
Grievance System. During the term of this Agreement, County shall establish and operate a system through which youths receiving Services, and the youths' parents or guardian, may present grievances about the delivery of the Services. At the time arrangements are made for delivery of Services to a particular youth, County shall advise the youth and the parents or guardian of the youth of the existence of this grievance system.
