MDHHS. BCAL 3305 (formerly OCAL 3305/BRS-3305) Page 2 of 2 Rev. July 2015
MDHHS reserves the right to update this benchmark based on overall participant performance, regular metric specification maintenance or other applicable events. In the event that the benchmark must be updated, MDHHS will provide sixty (60) days written notice to participants.
MDHHS. The Michigan Department of Health and Human Services was formerly two departments: the Michigan Department of Community Health and the Michigan Department of Human Services.
MDHHS must involve the Contractor, to the extent allowed by law, in matters relating to any legal or court activities concerning the youth while in the Contractor's care.
MDHHS. APPEALS shall provide copies of its action to the respondent, the appellant, recipient if different than appellant, the recipient's legal guardian, if any, the board of a CMHSP, the governing body of the LPH/U and the local office of recipient rights holding the record. If the appeal involves the findings of a MDHHSORR rights advisor, the MDHHS-XXX director shall also be provided copies of the action. If MDHHS-APPEALS upholds the findings of the office, notice shall be provided to the appellant of his/her legal right to seek redress through the circuit court. If MDHHS-APPEALS instructs that additional investigation be conducted, the director of MDHHS-XXX, the executive director of the CMHSP or the director of the LPH/U shall assure that such investigation is completed in a fair and impartial manner within 45 calendar days of his/her receipt of the written notice from MDHHS-APPEALS. The 45 calendar day time frame may be extended at the department's discretion upon a showing of good cause by the MDHHS-XXX director, CMHSP executive director or LPH/U director. At no time shall the time frame exceed 90 calendar days. In cases of re-investigation by MDHHS-ORR, the director of that office shall be responsible for the submission of the investigative report to the appropriate MDHHS facility director. Within 10 business days of the receipt of the investigative report, the facility director, executive director of the CMHSP, or the director of the LPH/U shall issue a Summary Report in compliance with section 782 of the Code to the department, appellant, recipient if different than appellant and the recipient's legal representative, if any, If the findings of the additional investigation remain the same as those appealed, the department shall inform appellant, recipient if different than appellant and the recipient's legal guardian, if any, in writing of the right to seek redress through the circuit court. Copies of this notice will be provided to the deputy director of the MDHHS Mental Health/Substance Abuse Services (if the investigation was conducted by staff of the MDHHS-XXX) the director of MDHHS Quality Management and Service Innovation (if the investigation was conducted by a CMHSP) or the Licensing Officer with the Psychiatric Licensure Unit of the MDHHS Division of Health Facility Licensing and Certification (if the investigation was conducted by an LPH/U). If the additional investigation results in the substantiation of previously unsubstantiated violation bu...
MDHHS. APPEALS shall review the record generated by the local appeal. [t shall not consider additional evidence or information that was not available during the local appeal. Within 30 calendar days after receiving the appeal, MDHHS-APPEALS shall review the appeal and do one of the following: Uphold the findings of the office. Affirm the decision of the Appeals Committee. Return the matter to the director of the department's Office of Recipient Rights, the executive director of the CMHSP or the director of the LPH/U with instruction for additional investigation or consideration.
MDHHS may consider reenrollment of beneficiaries disenrolled in these situations on a case-by-case basis.
MDHHS may use the results of performance assessments as part of the formula for bonus awards and/or automatic enrollment assignments. MDHHS will continually monitor the Contractor’s performance on the performance monitoring standards and make changes as appropriate. The performance monitoring standards are attached to the Contract (Appendix I); the performance bonus template is attached to the Contract (Appendix J).
MDHHS. BCAL 3305 (formerly OCAL 3305/BRS-3305) Page 2 of 2 Rev. July 2015 Billing Information Bank Draft - Voided Check or Bank Verification Needed Checking Savings Account Holder(s) Routing Number Last 4 digits of account number Credit/Debit Visa Master Card Discover Card Holder Card Number – – – Expiration Date / Billing Contact if different from primary member Name Phone Electronic Funds Transfer Agreement (please initial each line) By initialing each paragraph and signing this EFT Agreement I/we are allowing the YMCA of Greater Michiana (“YMCA”) to electronically withdraw or otherwise electronically access and obtain funds to pay recurring membership charges using the payment method(s) and source(s) selected above. I/we understand and agree that the YMCA will electronically withdraw or otherwise electronically access and obtain funds for recurring charges on the 10th day of each month, or shortly thereafter, and immediately for one-time charges for programs fees. I/we represent and warrant that the billing information provided above is accurate. I/we understand and agree that I/we shall hold harmless and indemnify the YMCA for any liability imposed upon or expense incurred by the YMCA for breach of this representation and warranty. I/we are responsible to provide written cancellation or change requests for my/our membership charges prior to the first day of the month it is to take effect. The YMCA will not automatically terminate membership or refund membership charges because of non-use of the YMCA facilities or services. I/we are responsible for payment of all amounts incurred for membership charges or program fees while my our membership is active or if my/our cancellation request is provided after the 1st of the month. The YMCA has the right to adjust my/our membership charges after providing 60-day written notice. The YMCA will attempt to collect declined membership charges from a credit/debit card up to 3 times. A $15 late fee will be applied and your membership will be suspended if not paid by the end of the month for which the charges are incurred. Non-sufficient funds available from electronically accessed checking/savings accounts will have a $15 NSF fee added and returned checks will have a $20 NSF fee. In either case, your membership will be suspended if not paid by the end of the month for which the charges are incurred If my/our membership is inactive for more than 30 days, I/we may be subject to pay a join fee when reactivating. I agree to the ...
MDHHS. BCAL 3305 (formerly OCAL 3305/BRS-3305) Rev. July 2015 I, , give permission to Little Treasures Early Childhood Center to Buyer Name charge my card for the following services. My payment details will be stored in my profile and will be used for the services provided. My payment will also be used for auto pay when payment is due based on the information below. There will be a 3% fee for credit/debit cards or a $1.00 fee for ACH bank accounts that is charged by the billing company for each transaction. You may choose to have your card and bank account on file or just a card on file. It is required to have a card on file. If payment is declined, the payment will be reprocessed. Child’s Name All Fields Required Buyer Email Services Provided Card Information Card Type MasterCard Discover VISA American Express Other Name On Card Card Number CVC Expiration Date Billing Zip Code ACH Information Bank Name: Routing Number: Billing Address: Name On Account: Account Number: Recurring Payment Information Card Will Be Charged Every: Week Month Charges Will Be Made On: For The Amount Of: I have thoroughly read through the tuition contract and agreement provided and understand the terms of agreement. Customer Signature: Date: Oakland County Early Childhood GSRP Paper Application (Information gathered needs to be uploaded into MiECC once child is enrolled) Intake School/Agency* Primary Phone Number* Family Name* Address* Apartment/Unit # City* State* Zip Code* Date Received*: Referral Source* Agency Parent Guardian Other Initial Contact Method Email Phone Walk In Other: How did you learn about us? Authorization to Share (please read this statement in full)*: Part of Oakland Schools is to support your family, which means we may refer you to another program or organization. Do you give permission to Oakland Schools to share the information you’ve given me today with affiliate/community organizations in order to best support your family? Information may also include the results of the Ages and Stages Questionnaire. This will remain in effect until the youngest child in the family turns five or your family requests, either verbally or in writing, that information sharing be stopped. Parent/Guardian Signature* For which year are you hoping to have your child enrolled or be considered for services? 2023-2024 2024-2025 Desired Program Schedule Part Day School Day - 4 days per week School Day - 5 days per week Child’s Legal First Name Middle Name Child’s Legal Last Name Suffix Dat...
