Other Discharge Appeals Sample Clauses

Other Discharge Appeals. The Contractor must comply with the termination of services Appeal requirements for individuals receiving services from a comprehensive outpatient rehabilitation facility, skilled nursing facilities, or home health agency at 42 C.F.R. §§ 422.624 and 422.626. Quality Improvement Program Quality Improvement (QI) Program The Contractor shall: Deliver quality care that enables Enrollees to stay healthy, get better, manage chronic illnesses and/or disabilities, and maintain/improve their quality of life. Quality care refers to: Quality of physical health care, including primary and specialty care; Quality of behavioral health care focused on recovery, resiliency and rehabilitation; Quality of LTSS; Adequate access and availability to primary, behavioral health care, specialty health care, pharmacy, and LTSS providers and services; Continuity and coordination of care across all care and services settings, and for transitions in care; and Enrollee experience and access to high quality, coordinated, and culturally competent clinical care and services, inclusive of LTSS across the care continuum. Apply the principles of continuous quality improvement (CQI) to all aspects of the Contractor’s service delivery system through ongoing analysis, evaluation and systematic enhancements based on: Quantitative and qualitative data collection and data‑driven decision‑making; Up‑to‑date evidence‑based practice guidelines and explicit criteria developed by recognized sources or appropriately certified professionals or, where evidence‑based practice guidelines do not exist, consensus of professionals in the field; Feedback provided by Enrollees and Network Providers in the design, planning, and implementation of its CQI activities; and Issues identified by the Contractor, EOHHS and/or CMS. Ensure that the QI requirements of this Contract are applied to the delivery of primary and specialty health care services, Behavioral Health Services, community‑based services, and LTSS. QI Program Structure The Contractor shall maintain a well‑defined QI organizational and program structure that supports the application of the principles of CQI to all aspects of the Contractor’s service delivery system. The QI program must be communicated in a manner that is accessible and understandable to internal and external individuals and entities, as appropriate. The Contractor’s QI organizational and program structure shall comply with all applicable provisions of 42 C.F.R. § 438, including Subpart D...
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Other Discharge Appeals. 2.11.6.1. The ICO must comply with the termination of services Appeal requirements for individuals receiving services from a comprehensive outpatient rehabilitation facility, skilled nursing facilities, or home health agency at 42 C.F.R. §§ 422.624 and 422.626. 2.12. Provider Appeals
Sample 1
Other Discharge Appeals. 1. The Contractor must comply with the termination of services Appeal requirements for individuals receiving services from a comprehensive outpatient rehabilitation facility, skilled nursing facilities, or home health agency at 42 C.F.R. §§ 422.624 and 422.626.
Sample 1

Related to Other Discharge Appeals

  • DISCIPLINE AND DISCHARGE CASES 13:01 An employee who is discharged by the Employer shall, as soon as may be practicable thereafter, be given written notice thereof and a copy of such notice shall, within seven (7) working days after such discharge, be forwarded to the President of the Union, which said Notice shall contain the reason for the discharge of the said employee.

  • DISCHARGE, SUSPENSION AND DISCIPLINE 14.01 (a) In the event an Employee is suspended as a disciplinary measure and the Employee considers that an injustice has been done, the matter may be taken up at Step 2 of the Grievance Procedure.

  • DISCHARGE AND DISCIPLINE CASES 10.01 Whenever the Corporation deems it necessary to censure an employee in writing, in a manner indicating that dismissal or suspension may follow, the Corporation shall within five (5) working days thereafter, give written particulars of such censure to the President of the Union, with a copy to the employee involved.

  • DISCIPLINE, SUSPENSION AND DISCHARGE 14.01 The Employer shall not discipline, suspend or discharge any employee except for just cause.

  • DISCHARGE AND DISCIPLINARY PROCEDURE 8.01 Management shall not take disciplinary action without first warning the employee, unless the circumstances justify immediate suspension or discharge. In the event of a claim that an employee has been discharged or suspended unjustly or unreasonably, the grievance shall be filed at Step Three (3) of the grievance procedure within five (5) working days.

  • DISMISSAL, SUSPENSION AND DISCIPLINE 13 11.1 Procedure 13 11.2 Dismissal and Suspension 13 11.3 Burden of Proof 13 11.4 Right to Grieve Other Disciplinary Action 13 11.5 Personnel File 13 11.6 Right to Have Union Representative Present 14 11.7 Abandonment of Position 14 11.8 Probation 14 11.9 Employee Investigations 15 ARTICLE 12 - SENIORITY 15 12.1 Seniority Defined 15 12.2 Seniority List 16 12.3 Loss of Seniority 16 12.4 Re-Employment 17 12.5 Bridging of Service 17 12.6 Same Seniority 17 ARTICLE 13 - LAYOFF AND RECALL 17 13.1 Definition of a Layoff 17 13.2 Pre-Layoff Canvass 17 13.3 Layoff 18 13.4 Bumping 18 13.5 Recall 19 13.6 Advance Notice 19 13.7 Grievance on Layoffs and Recalls 19 13.8 Worksite Closure 19 ARTICLE 14 - HOURS OF WORK 20 14.1 Definitions 20 14.2 Hours of Work 20 14.3 Rest Periods 21 14.4 Meal Periods 22 14.5 Flextime 22 14.6 Staff Meetings 22 (ii) 14.7 Standby Provisions 22 14.8 Conversion of Hours 23 ARTICLE 15 - SHIFTS 23 15.1 Exchange of Shifts 23 15.2 Shortfall of Shifts 23 15.3 Short Changeover Premium 23 15.4 Split Shifts 23 15.5 Work Schedules 23 ARTICLE 16 - OVERTIME 24 16.1 Definitions 24 16.2 Overtime Entitlement 24 16.3 Recording of Overtime 24 16.4 Sharing of Overtime 24 16.5 Overtime Compensation 24 16.6 No Layoff to Compensate for Overtime 24 16.7 Right to Refuse Overtime 25 16.8 Callback Provisions 25 16.9 Rest Interval 25 16.10 Overtime for Part-Time Employees 25 16.11 Authorization and Application of Overtime 25 ARTICLE 17 - HOLIDAYS 26 17.1 Paid Holidays 26 17.2 Holiday Falling on Saturday or Sunday 26 17.3 Holiday Falling on a Day of Rest 26

  • DISCIPLINE AND DISCHARGE 21.01 The Employer may warn, suspend, demote or discharge employees for just cause. If the conduct or performance of an employee warrants disciplinary action, such action shall be confirmed in writing. A copy of all such documentation shall be provided to the employee(s) involved and forwarded to the office of the Union at the time they are issued.

  • Suspension and Discharge An employee who has not completed the probationary period may be released without appeal through the grievance procedure. Employees having successfully completed their probationary period shall only be disciplined or discharged for just cause. Prior to suspending or discharging an employee, provided they have completed their probationary period, such employee and the Union Xxxxxxx shall be given the reasons in writing, by the Employer, for the suspension or discharge.

  • Appeal of Discharge or Discipline Should the discharged or disciplined employee consider the discharge or discipline to be improper, a grievance shall be presented in writing as provided in the grievance procedure. In cases of discharge, or discipline resulting in suspension, the grievance shall be filed at Step 2 of the grievance procedure within 10 days of the discharge.

  • DISCIPLINE/DISCHARGE 21.01 The Employer may warn, suspend, demote or discharge an employee for just cause. If the conduct or performance of an employee warrants disciplinary action, such action shall be confirmed in writing. A copy of all such documentation shall be provided to the employee(s) involved, and forwarded to the office of the Union at the time they are issued.

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