Common use of Notices of Action & Grievance, Appeal and Fair Hearing Procedures Clause in Contracts

Notices of Action & Grievance, Appeal and Fair Hearing Procedures. The Contractor must provide specific information regarding member grievance, appeal 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.

Notices of Action & Grievance, Appeal and Fair Hearing Procedures. The Contractor must provide specific information regarding member grievance, appeal 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.

Notices of Action & Grievance, Appeal and Fair Hearing Procedures. The Contractor must provide specific information regarding member grievance, appeal 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.

Notices of Action & Grievance, Appeal and Fair Hearing Procedures. The Contractor must provide specific information regarding member grievance, appeal 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 EXHIBIT 1.M SCOPE OF WORK 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.