Common use of Process for Expedited Appeals Clause in Contracts

Process for Expedited Appeals. (A) The Contractor shall establish and maintain an expedited Appeal process when: (1) the Contractor determines, based either upon a request from an Aggrieved Person or in the Contractor’s own judgment, that the standard timeframe for Appeal could seriously jeopardize the Enrollee’s life, physical and/or mental health, or ability to attain, maintain or regain maximum function; or (2) a Provider indicates that the standard timeframe for Appeal could seriously jeopardize the Enrollee’s life, physical and/or mental health, or ability to attain, maintain or regain maximum function.