Common use of Grievances and Appeals Clause in Contracts

Grievances and Appeals. 19.1 42 C.F.R. § 438.400 defines the term “grievance” to mean an expression of dissatisfaction about any matter other than an Adverse Benefit Determination. It includes, but is not limited to, the quality of care or services provided, aspects of interpersonal relationships such as rudeness of a provider or employee, failure to respect the beneficiary’s rights regardless of whether remedial action is requested, and the beneficiary’s rights to dispute an extension of time proposed by the MHP to make an authorized decision.

Grievances and Appeals. 19.1 42 C.F.R. § 438.400 defines the term “grievance” to mean an expression of dissatisfaction about any matter other than an Adverse Benefit Determination. It includes, but is not limited to, the quality of care or services provided, aspects of interpersonal relationships such as rudeness of a provider or employee, failure to respect the beneficiary’s rights regardless of whether remedial action is requested, and the beneficiary’s rights to dispute an extension of time proposed by the MHP to make an authorized decision.