Common use of FILING GRIEVANCES Clause in Contracts

FILING GRIEVANCES. Grievance is defined at 2.11 and includes an enrollee’s right to dispute an extension of time proposed by DVHA to make authorization decisions, to extend the timeline for a notice of a notice of resolution of an internal appeal, and whenever an expedited appeal request is denied as not meeting the expedited standard. A grievance may be expressed orally or in writing by the enrollee and/or their representative. A provider may serve as the enrollee's representative for the purpose of filing a grievance and assisting the enrollee with the proceedings of the grievance. Individuals may file a grievance through DVHA Customer Service or directly with any department. A beneficiary or his or her designated representative can file a grievance at any time and the grievance must be considered. In handling grievances, DVHA must give any reasonable assistance to the enrollee in initiating and participating in the grievance, including completing forms, taking procedural steps related to the grievance, and providing auxiliary aids and services such as interpreter services and toll-free numbers that have adequate TTY/TTD interpreter capability. DVHA must have a process to ensure that the individuals who make decisions on grievances are individuals who: • Are not involved in any previous level of review or decision-making and are not a subordinate of such individual. • Are health care professionals who have the appropriate clinical expertise in treating the beneficiary’s condition or disease, if deciding a grievance regarding the denial of expedited resolution of an appeal, or a grievance that involves a clinical issue.

FILING GRIEVANCES. Grievance is defined at 2.11 and includes an enrollee’s right to dispute an extension of time proposed by DVHA to make authorization decisions, to extend the timeline for a notice of a notice of resolution of an internal appeal, and whenever an expedited appeal request is denied as not meeting the expedited standard. A grievance may be expressed orally or in writing by the enrollee and/or their representative. A provider may serve as the enrollee's representative for the purpose of filing a grievance and assisting the enrollee with the proceedings of the grievance. Individuals may file a grievance through DVHA Customer Service or directly with any department. A beneficiary or his or her designated representative can must file a any grievance at any time and within 60 days of the pertinent issue in order for the grievance must to be considered. (No later than January 1, 2018, DVHA must allow an enrollee to grieve at any time, that is eliminate the 60-day time limit.) In handling grievances, DVHA must give any reasonable assistance to the enrollee in initiating and participating in the grievance, including completing forms, taking procedural steps related to the grievance, and providing auxiliary aids and services such as interpreter services and toll-toll free numbers that have adequate TTY/TTD interpreter capability. DVHA must have a process to ensure that the individuals who make decisions on grievances are individuals who: • Are not involved in any previous level of review or decision-making and are not a subordinate of such individual. • Are health care professionals who have the appropriate clinical expertise in treating the beneficiary’s condition or disease, if deciding a grievance regarding the denial of expedited resolution of an appeal, or a grievance that involves a clinical issue.