PROVIDER PANEL EXCEPTIONS Sample Clauses

PROVIDER PANEL EXCEPTIONS. ODJFS may specify provider panel criteria for a service area that deviates from that specified in this appendix if: - the MCP presents sufficient documentation to ODJFS to verify that they have been unable to meet or maintain certain provider panel requirements in a particular service area despite all reasonable efforts on their part to secure such a contract(s), and - if notified by ODJFS, the provider(s) in question fails to provide a reasonable argument why they would not contract with the MCP, and - the MCP presents sufficient assurances to ODJFS that their members will have adequate access to the services in question. If an MCP is unable to contract with or maintain a sufficient number of providers to meet the ODJFS-specified provider panel criteria, the MCP may request an exception to these criteria by submitting a provider panel exception request as specified by ODJFS. ODJFS will review the exception request and determine whether the MCP has sufficiently demonstrated that all reasonable efforts were made to obtain contracts with providers of the type in question and that they will be able to provide access to the services in question. ODJFS will aggressively monitor access to all services related to the approval of a provider panel exception request through a variety of data sources, including: consumer satisfaction surveys; member appeals/grievances/complaints and state hearing notifications/requests; member just-cause for termination requests; clinical quality studies; encounter data volume; provider complaints, and clinical performance measures. ODJFS approval of a provider panel exception request does not exempt the MCP from assuring access to the services in question. If ODJFS determines that an MCP has not provided sufficient access to these services, the MCP may be subject to sanctions.
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PROVIDER PANEL EXCEPTIONS. If an MCP presents sufficient documentation to ODJFS to verify that they have been unable to meet certain minimum provider panel requirements in a particular service area despite all reasonable efforts on the part of the MCP to secure such a contract(s), ODJFS may specify minimum provider panel criteria for that service area which deviate from those specified in this appendix.
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PROVIDER PANEL EXCEPTIONS. Failure to contract with, and properly report to the MCPN, all MCP- contracted providers will result in sanctions as outlined in Appendix N. ODM will grant an exception to the issuance of a sanction only when an action taken by ODM has adversely impacted a plan’s ability to meet the provider panel network standards.
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PROVIDER PANEL EXCEPTIONS. ODJFS may specify provider panel criteria for a service area that deviates from that specified in this appendix if:
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Related to PROVIDER PANEL EXCEPTIONS

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  • Personnel Matters 7.1 Verbal or written complaints regarding an employee made to any member of the Administration by any parent, student or other person which is to be placed in any personnel file or which may be used to evaluate or discipline an employee shall be promptly investigated. The employee shall be given prompt notice of such complaint and shall be given the opportunity to respond to the complaint. Unsubstantiated complaints shall not be placed in an employee’s file.

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