Common use of Grievance System Clause in Contracts

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. 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 3225 through 410-141-32643255, and 42 CFR 438.402 438.400 through 438.414438.424. 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, Notice of Adverse Benefit Determination, 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. (7) Contractor shall monitor the compliance of its subcontractor and provider network to all Grievance and Appeal requirements outlined in federal and State law and the provisions of this contract.

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 3225 through 410-141-32643255, and 42 CFR 438.402 438.400 through 438.414438.424. 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, Notice of Adverse Benefit Determination, 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. 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 3225 through 410-141-32643255, and 42 CFR 438.402 438.400 through 438.414438.424. 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, Notice of Adverse Benefit Determination, 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. (7) Contractor shall monitor the compliance of its subcontractor and provider network to all Grievance and Appeal requirements outlined in federal and State law and the provisions of this contract.

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.