Urgent grievance definition
Urgent grievance means a grievance where using the standard timeframe of the grievance process would: (a) seriously jeopardize the life or health of a member; or (b) would jeopardize the member’s ability to regain maximum function.
Urgent grievance a request for a Health Service that, if subject to the time limits applicable to Post-service Grievances or Pre-Service Grievances would do either of the following.
Urgent grievance means an adverse determi- nation when the standard timeframe of the grievance procedure would seriously jeopardize the life or health of a subscriber or would jeopardize the subscriber’s ability to regain maximum function.
More Definitions of Urgent grievance
Urgent grievance an adverse determination when the standard timeframe of the grievance procedure would seriously jeopardize the life or health of an enrollee, or the enrollee's ability to regain maximum function. Violation - each determination by the department and/or agency that a contractor failed to act as specified in the contract or in applicable statutes or rules governing Medicaid prepaid health plans. Each day that an ongoing violation continues may be considered for the purposes of this contract to be a separate violation. In addition, each instance of failing to furnish necessary and/or required services or items to enrollees is considered for purposes of this contract to be a separate violation. Attachment I- 7 of 55 Contract No. ▇▇▇▇-▇▇▇▇-▇▇ LONG-TERM CARE COMMUNITY DIVERSION PILOT PROJECT REQUIREMENTS SECTION GENERAL CONTRACT REQUIREMENTS CONTRACTOR QUALIFICATIONS To qualify as a long-term care community diversion program contractor, the contractor must: A. Have a certificate of authority from the Florida Department of Insurance to operate as a health maintenance organization (HMO) pursuant to Chapter 641 Part I, Florida Statutes, and have a health care provider certificate from the Agency for Health Care Administration (agency) pursuant to Chapter 641.49, Florida Statutes, for those counties in the service area in which the applicant will apply to provide services or; B. Have a license issued pursuant to Chapter 400, Florida Statutes, and meet the provisions of an "other qualified provider" set forth in Section 430.703(7), Florida Statutes, including satisfying all financial and quality assurance requirements for a provider service network as specified in Section 409.912, Florida Statutes, and; C. Have, or have a subcontractor that has, prior experience in providing home and community-based long-term care services in the project service area and; D. Have the capacity to integrate the delivery of acute and long-term care services to enrollees; and E. Meet all the requirements to enroll as a Medicaid prepaid health services provider; and F. Meet all other requirements in the remaining provisions of this contract and its attachments.
Urgent grievance. A written complaint from a member expressing dissatisfaction with: o Any request to reconsider as adverse initial determination (denial of service) o Written appeal to a previous determination of a urgent complaint that, if left unresponded to, has the potential to become an emergency. All grievances triaged as "urgent" will be fully responded to within 48 hours of APSH PR notification of the complaint. PROCEDURE:
Urgent grievance means an adverse determination when the standard time frame of the grievance procedure would seriously jeopardize the dental health of a member or would jeopardize the member’s ability to regain maximum function. Vendor – an individual or entity that engages in the business of selling care, goods, services, or commodities. Violation - each determination by the Agency that a PDHP failed to act as specified in the contract or in applicable statutes or rules governing Medicaid PDHPs. Each day that an ongoing violation continues may be considered for the purposes of this contract to be a separate violation. In addition, each instance of failing to furnish necessary and/or required dental services or items to beneficiaries is considered for purposes of this contract to be a separate violation. 110.0 EXHIBITS 110.1 FLORIDA PATIENT’S BILL OF RIGHTS AND RESPONSIBILITIES
Urgent grievance means an adverse determination