Participating Plan Grievances and Internal Appeals Processes Sample Clauses

Participating Plan Grievances and Internal Appeals Processes. CMS and the Commonwealth agree to develop a unified set of requirements for Participating Plan grievances and internal appeals processes that incorporate relevant Medicare Advantage, and Medicaid managed care requirements, to create a more beneficiary-friendly and easily navigable system, which is discussed in further detail in Appendix 7 and will be specified in the three-way contract. All Participating Plan Grievances and Internal Appeals procedures shall be subject to the review and prior approval of CMS and the Commonwealth. Part D appeals and grievances will continue to be managed under existing Part D rules, and non-Part D pharmacy appeals will be managed by MassHealth. CMS and MassHealth will work to continue to coordinate grievances and appeals for pharmacy.
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Participating Plan Grievances and Internal Appeals Processes. Over the period of the Demonstration, CMS and California agree to develop a unified set of requirements for Participating Plan grievances and internal appeals processes that incorporate relevant Medicare Advantage, and Medicaid managed care requirements, to create a more beneficiary friendly and easily navigable system, which is discussed in further detail in Appendix 7 and will be specified in the three-way contract. All Participating Plan Grievances and Internal Appeals procedures shall be subject to the review and prior approval of CMS and California. Part D appeals and grievances will continue to be managed by CMS under existing Part D rules, and non-Part D pharmacy appeals will be managed by California. CMS and California will work to continue to coordinate grievances and appeals for pharmacy. The IHSS fair hearing processes will continue for IHSS hours authorized by counties. More detail is specified in Appendix 7.
Sample 1
Participating Plan Grievances and Internal Appeals Processes. CMS and DMAS agree to develop a unified set of requirements for Participating Plan grievances and internal appeals processes that incorporate relevant Medicare Advantage, and Medicaid managed care requirements, to create a more beneficiary-friendly and easily navigable system. All Participating Plan Grievances and Internal Appeals procedures shall be subject to the review and prior approval of CMS and DMAS. Medicare Part D appeals and grievances will continue to be managed by CMS under existing Part D rules, and Medicaid non-Part D pharmacy appeals will be managed by DMAS. CMS and DMAS will work to continue to coordinate grievances and appeals for all services.
Sample 1

Related to Participating Plan Grievances and Internal Appeals Processes

  • COMPLAINT AND GRIEVANCE PROCEDURE 1. When a member of the bargaining unit has any grievance or complaint, he shall forthwith convey to his immediate superior, orally with or without a member of the Association Executive or in writing, all facts relative to the grievance and/or complaint. The member and the superior shall make every attempt to resolve the problem at this preliminary stage.

  • CENTRAL GRIEVANCE PROCEDURE 15.1 Effective until April 30, 2019, this procedure applies to differences:

  • DISCIPLINARY AND GRIEVANCE PROCEDURES 16.1 The Employee is subject to the Company's disciplinary and grievance procedures, copies of which are available from the Group HR Manager. These procedures do not form part of the Employee's contract of employment.

  • PROFESSIONAL GRIEVANCE PROCEDURE A. A claim by a teacher, the Association, or the Board of Education that there has been a violation, misinterpretation or misapplication of specific provisions of this Agreement may be processed as a grievance as hereinafter provided.

  • Grievances and Appeals a. If you have questions about any pediatric dental services received, please first discuss the matter with your Dental Provider. However, if you continue to have concerns, please call Delta Dental’s Customer Service Center. You can also email questions by accessing the “Contact Us” section of the dental plan website at xxx.xxxxxxxxxxxxxx.xxx.

  • Rules of Grievance Processing 1. Time limits of any stage of the grievance procedure may be extended by written mutual agreement of the parties at that step.

  • COMPLAINT PROCEDURES CONTRACTOR shall maintain and adhere to its written procedures for responding to parent complaints. These procedures shall include annually notifying and providing parents of LEA pupils with appropriate information (including complaint forms) for the following: (1) Uniform Complaint Procedures pursuant to Title 5 of the California Code of Regulations section 4600 et seq.; (2) Nondiscrimination policy pursuant to Title 5 of the California Code of Regulations section 4960 (a); (3) Sexual Harassment Policy, California Education Code 231.5 (a) (b) (c); (4) Title IX Pupil Grievance Procedure, Title IX 106.8 (a) (d) and 106.9 (a); and (5) Notice of Privacy Practices in compliance with Health Insurance Portability and Accountability Act (HIPPA). CONTRACTOR shall include verification of these procedures to the LEA.

  • Appeals Process A. The Contractor’s appeal process shall, at a minimum:

  • Grievance Procedures The AGENCY agrees to establish a formal written grievance process with procedures through which clients and recipients of services may present grievances to the governing authority of the AGENCY regarding services being provided under this Contract. Additionally, the AGENCY agrees to establish fair hearing procedures that ensure all persons will be advised of their rights to a fair hearing to appeal a denial or exclusion from services and/or the failure of staff to take into account the individual’s choice of service. The AGENCY’S internal grievance procedure must document and include, at a minimum, the following: date of grievance, a written response to the applicant sent within thirty (30) days, and the opportunity for the applicant to meet with the AGENCY Executive Director or designee. Upon request by the COUNTY, the AGENCY shall provide a written report as to the grievance outcome within five (5) normal COUNTY working days. The AGENCY will maintain these documents on file for review by the COUNTY.

  • The Grievance Procedure Step I. A grievance may be submitted within the thirty (30) day period specified in Section Five to the employee’s first management supervisor in the chain of command (e.g., Bureau Chief) who is outside the bargaining unit. Such supervisor shall meet with the union representative and/or the grievant and issue a written response within seven (7) days after such meeting but not later than ten

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