Common use of Participating Plan Grievances and Internal Appeals Processes Clause in Contracts

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.

Participating Plan Grievances and Internal Appeals Processes. CMS and the Commonwealth State agree to develop a unified set of requirements for Participating Plan grievances and internal appeals processes that incorporate relevant requirements that are at least as beneficiary-friendly as Medicare Advantage, and Medicaid managed care requirementscare, 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 CommonwealthState. 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 MassHealththe State. CMS and MassHealth the State will work to continue to coordinate grievances and appeals for pharmacy.