Common use of Timeframes for Grievance Disposition and Notification Clause in Contracts

Timeframes for Grievance Disposition and Notification. (A) The Contractor shall dispose of each Grievance and provide notice to the affected parties as expeditiously as the Enrollee’s health condition requires, but not to exceed 90 calendar days from the day the Contractor receives the Grievance. (B) For written Grievances, the Contractor shall notify the affected parties in writing of the disposition of the Grievance. For Grievances received orally, the Contractor shall notify the affected parties of the disposition either orally or in writing. The notice of Grievance disposition shall satisfy format and language requirements in 42 CFR 438.10. (C) If the Enrollee, the Enrollee’s legal guardian or other authorized representative, or a Provider files a Grievance with the Department, the Department shall apprise the individual of the right to file the Grievance with the Contractor and how to do so. (D) If the individual prefers, the Department shall promptly notify the Contractor of the Grievance. (E) If the Contractor receives the Grievance from the Department, the Contractor shall follow the procedures and timeframes outlined above for Grievances. (F) If the Contractor receives the Grievance from the Department, the Contractor shall notify the affected parties and the Department, in writing, of the disposition of the Grievance. (G) The Contractor may extend the timeframe for disposing of the Grievance and providing notice by up to 14 calendar days if: (1) the Enrollee requests the extension; or (2) the Contractor shows that there is need for additional information and how the delay is in the Enrollee’s interest (upon Department request). (H) If the Contractor extends the time frame, and the extension was not requested by the Enrollee, the Contractor shall: (1) make reasonable efforts to give the Enrollee prompt oral notice of the delay; and (2) give the Enrollee written notice within two calendar days of the decision to extend the timeframe and inform the Enrollee of the right to file a Grievance about the decision.

Timeframes for Grievance Disposition and Notification. (A) The Contractor shall dispose of each Grievance and provide notice to the affected parties as expeditiously as the EnrolleeAggrieved Person’s health condition requires, but not to exceed 90 calendar days from the day the Contractor receives the Grievance. (B) For written Grievances, the Contractor shall notify the affected parties in writing of the disposition of the Grievance. For Grievances received orally, the Contractor shall notify the affected parties of the disposition either orally or in writing. The notice Notice of Grievance disposition Disposition shall satisfy format and language requirements in 42 CFR 438.10. (C) If the Enrollee, the Enrollee’s legal guardian or other authorized representative, or a Provider Aggrieved Person files a Grievance with the Department, the Department shall apprise the individual Enrollee or the Provider, of the their right to file the Grievance with the Contractor and how to do so. (D1) If the individual Individual prefers, the Department shall promptly notify the Contractor of the Aggrieved Person’s Grievance. (E2) If the Contractor receives the Grievance from the Department, the Contractor shall follow the procedures and timeframes time frames outlined above for Grievances. (F3) If the Contractor receives the Grievance from the Department, the Contractor shall notify the affected parties and the Department, in writing, of the disposition of the Grievance. (GD) The Contractor may extend the timeframe for disposing of the Grievance and providing notice by up to 14 calendar days if: (1) the Enrollee Aggrieved Person requests the extension; or (2) the Contractor shows that there is a need for additional information and how the delay is in the Enrollee’s interest (upon Department request). (HE) If the Contractor extends the time frame, and the extension was not requested by the EnrolleeAggrieved Person, the Contractor shall: (1) make reasonable efforts to give the Enrollee Aggrieved Person prompt oral notice of the delay; and (2) give the Enrollee Aggrieved Person written notice notice, within two calendar days days, of the decision to extend the timeframe and inform the Enrollee Aggrieved Person of the right to file a Grievance State Fair Hearing about the decision.

Timeframes for Grievance Disposition and Notification. (A) The Contractor shall dispose of each Grievance and provide notice to the affected parties as expeditiously as the Enrollee’s health condition requires, but not to exceed 90 calendar days from the day the Contractor receives the Grievance. (B) For written Grievances, the Contractor shall notify the affected parties in writing of the disposition of the Grievance. For Grievances received orally, the Contractor shall notify the affected parties of the disposition either orally or in writing. The notice Notice of Grievance disposition shall satisfy format and language requirements in 42 CFR 438.10. (C) If the Enrollee, the Enrollee’s legal guardian or other authorized representative, or a Provider files a Grievance with the Department, the Department shall apprise the individual or the Provider, of the Enrollee’s right to file the Grievance with the Contractor and how to do so. (D1) If the individual or Provider prefers, the Department shall promptly notify the Contractor of the Enrollee’s Grievance. (E2) If the Contractor receives the Grievance from the Department, the Contractor shall follow the procedures and timeframes outlined above for Grievances. (F3) If the Contractor receives the Grievance from the Department, the Contractor shall notify the affected parties and the Department, in writing, of the disposition of the Grievance. (GD) The Contractor may extend the timeframe for disposing of the Grievance and providing notice by up to 14 calendar days if: (1) the Enrollee requests the extension; or (2) the Contractor shows that there is need for additional information and how the delay is in the Enrollee’s interest (upon Department request). (HE) If the Contractor extends the time frametimeframe, and the extension was not requested by the Enrollee, the Contractor shall: (1) make reasonable efforts to give the Enrollee prompt oral notice of the delay; and (2) give the Enrollee written notice notice, within two calendar days days, of the decision to extend the timeframe and inform the Enrollee of the right to file a Grievance about the decision.