Common use of Member Notices of Action & Grievance Clause in Contracts

Member Notices of Action & Grievance. Appeal and Fair Hearing Procedures The Contractor must provide specific information regarding member grievance, appeal, external grievance procedure (External Review by Independent Review Organization), and State fair hearing procedures and timeframes to members, as well as providers and subcontractors at the time they enter into a contract with the Contractor. This information shall be included in the Member Handbook as described in Section 4.4.2. The information provided must be approved by FSSA in accordance with Section 4.9 and, as required under 42 CFR 438.10(g)(2)(xi), include the following: ▪ The right to file grievances and appeals; ▪ The requirements and timeframes for filing a grievance or appeal; ▪ The availability of assistance in the filing process; ▪ The toll-free numbers that the member can use to file a grievance or appeal by phone; ▪ The fact that, if requested by the member and under certain circumstances: 1) benefits will continue if the member files an appeal or requests a State fair hearing within the specified timeframes; and 2) the member may be required to pay the cost of services furnished during the appeal if the final decision is adverse to the member; and ▪ In the case of an FSSA fair hearing: • The right to a hearing; • The method for obtaining a hearing; and • The rules that govern representation at the hearing.

Member Notices of Action & Grievance. Appeal and Fair Hearing Procedures The Contractor must provide specific information regarding member grievance, appeal, external grievance procedure (External Review by Independent Review Organization), and State fair hearing procedures and timeframes to members, as well as providers and subcontractors at the time they enter into a contract with the Contractor. This information shall be included in the Member Handbook as described in Section 4.4.2. The information provided must be approved by FSSA in accordance with Section 4.9 and, as required under 42 CFR 438.10(g)(2)(xi), include the following: ▪ • The right to file grievances and appeals; ▪ • The requirements and timeframes for filing a grievance or appeal; ▪ • The availability of assistance in the filing process; ▪ • The toll-free numbers that the member can use to file a grievance or appeal by phone; ▪ • The fact that, if requested by the member and under certain circumstances: 1) benefits will continue if the member files an appeal or requests a State fair hearing within the specified timeframes; and 2) the member may be required to pay the cost of services furnished during the appeal if the final decision is adverse to the member; and ▪ In the case of an FSSA fair hearing: • The right to a hearing; • The method for obtaining a hearing; and • The rules that govern representation at the hearing.appeal

Member Notices of Action & Grievance. Appeal and Fair Hearing Procedures The Contractor must provide specific information regarding member grievance, appeal, external grievance procedure (External Review by Independent Review Organization), and State fair hearing procedures and timeframes to members, as well as providers and subcontractors at the time they enter into a contract with the Contractor. This information shall be included in the Member Handbook as described in Section 4.4.2. The information provided must be approved by FSSA in accordance with Section 4.9 and, as required under 42 CFR 438.10(g)(2)(xi), include the following: ▪ • The right to file grievances and appeals; ▪ • The requirements and timeframes for filing a grievance or appeal; ▪ • The availability of assistance in the filing process; ▪ • The toll-free numbers that the member can use to file a grievance or appeal by phone; ▪ • The fact that, if requested by the member and under certain circumstances: 1) benefits will continue if the member files an appeal or requests a State fair hearing within the specified timeframes; and 2) the member may be required to pay the cost of services furnished during the appeal if the final decision is adverse to the member; and ▪ In the case of an FSSA fair hearing: • The right to a hearing; • The method for obtaining a hearing; and • The rules that govern representation at the hearing.and