Common use of Grievances and Appeals Clause in Contracts

Grievances and Appeals. ‌ Insurer shall have a Grievance and Appeal system in place for Enrollees in compliance with 42 CFR 457.1260. The Grievance and Appeal system shall be the same for Title XXI Enrollees and Full-pay Plan Enrollees. Insurer shall establish and maintain policies and procedures for the Grievance and Appeal system, including procedures for expedited Appeals. Insurer shall provide its Grievance and Appeal policies and procedures to FHKC by the date established in the approved implementation plan and at least sixty (60) Calendar Days prior to any proposed changes. The initial policy and procedures and any subsequent changes are subject to approval by FHKC. Insurer shall provide its Grievance and Appeal policies and procedures to Providers and Subcontractors when Insurer engages with such entities or individuals and after any approved changes. Insurer shall ensure individuals making decisions about Grievances and Appeals:

Grievances and Appeals. ‌ Insurer shall have a Grievance and Appeal system in place for Enrollees in compliance with 42 CFR 457.1260. The Grievance and Appeal system shall be the same for Title XXI Enrollees and Full-pay Plan Enrollees. Insurer shall establish and maintain policies and procedures for the Grievance and Appeal system, including procedures for expedited Appeals. Insurer shall provide its Grievance and Appeal policies and procedures to FHKC by the date established in the approved implementation plan and at least sixty (60) Calendar Days prior to any proposed changes. The initial policy and procedures and any subsequent changes are subject to approval by FHKC. Insurer shall provide its Grievance and Appeal policies and procedures to Providers and Subcontractors when Insurer engages enters into a written agreement with such entities or individuals and after any approved changes. Insurer shall ensure individuals making decisions about Grievances and Appeals: