Grievance and Appeal Policies and Procedures Sample Clauses

The Grievance and Appeal Policies and Procedures clause establishes a formal process for individuals or parties to raise concerns, complaints, or disputes regarding the agreement or its implementation. Typically, this clause outlines the steps for submitting a grievance, the timeline for review, and the process for appealing decisions if the initial resolution is unsatisfactory. By providing a clear and structured mechanism for addressing issues, this clause ensures fairness, transparency, and an opportunity for resolution before resorting to legal action.
Grievance and Appeal Policies and Procedures. The ADRC shall implement due process policies and procedures to review and resolve grievances and inform people of their appeal rights, consistent with the Department’s Grievance and Appeal Policy found on the ADRC SharePoint site.
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Grievance and Appeal Policies and Procedures. Contractor must establish and maintain an internal process for the resolution of Grievances and Appeals from Enrollees.
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Grievance and Appeal Policies and Procedures a. Contractor must establish and maintain an internal process for the resolution of grievances and appeals from Enrollees. b. Contractor must have written policies and procedures governing the resolution of grievances and appeals.‌ c. An Enrollee, or a third party acting on behalf of an Enrollee, may file a grievance or appeal, orally or in writing, on any aspect of covered services as specified in the definitions of grievance and appeal. Unless an Enrollee requests an expedited resolution, an oral appeal must be followed by a written, signed appeal. d. MDHHS must approve Contractor’s grievance and appeal policies prior to implementation. These written policies and procedures must meet the following requirements: i. Except as specifically exempted in this section, the Contractor must administer an internal grievance and appeal procedure according to the requirements of MCL 500.2213 and 42 CFR 438.400 – 438.424 (Subpart F) ii. Contractor must cooperate with the Michigan Department of Insurance and Financial Services (DIFS) in the implementation of MCL 550.1901-1929, “Patient’s Rights to Independent Review Act”
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Grievance and Appeal Policies and Procedures a. Contractor must establish and maintain an internal process for the resolution of grievances and appeals from Enrollees. b. Contractor must have written policies and procedures governing the resolution of grievances and appeals. c. An Enrollee, or a third party acting on behalf of an Enrollee, may file a grievance or appeal, orally or in writing, on any aspect of covered services as specified in the definitions of grievance and appeal. d. MDHHS must approve Contractor’s grievance and appeal policies prior to implementation. These written policies and procedures must meet the following requirements: i. Except as specifically exempted in this section, the Contractor must administer an internal grievance and appeal procedure according to the requirements of MCL 500.2213 and 42 CFR 438.400 – 438.424 (Subpart F) ii. Contractor must cooperate with the Michigan Department of Insurance and Financial Services (DIFS) in the implementation of MCL 550.1901-1929, “Patient’s Rights to Independent Review Act.”
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Grievance and Appeal Policies and Procedures. The MCO shall have a timely and organized Grievance and Appeal Process with written policies and procedures for resolving Grievances filed by Members. The Grievance and Appeal Process shall address Members’ oral and written grievances. The Grievance and Appeal Process shall be approved in writing by the Department prior to implementation and shall be conducted in accordance with 42 CFR 438 subpart F, 907 KAR 17:010 and other applicable CMS and Department requirements. These policies and procedures shall include, but not be limited to: A. A process for evaluating patterns of grievances for impact on the formulation of policy and procedures, access and utilization; B. Procedures for maintenance of records of grievances separate from medical case records and in a manner which protects the confidentiality of Members who file a grievance or appeal; C. Ensure individuals who make decisions on grievances and appeals were not involved in any prior level of review; D. If the grievance involves a Medical Necessity determination, ensure that the grievance and appeal is heard by health care professionals who have the appropriate clinical expertise; E. Process for informing Members, orally and/or in writing, about the MCO’s Grievance and Appeal Process by making information readily available at the MCO’s office, by distributing copies to Members upon enrollment; and by providing it to all subcontractors at the time of contract or whenever changes are made to the Grievance and Appeal Process; F. Provide assistance to Members in filing a grievance if requested or needed; G. Include assurance that there will be no discrimination against a Member solely on the basis of the Member filing a grievance or appeal; H. Include notification to Members regarding how to access the Cabinet’s ombudsmen’s office regarding grievances, appeals and hearings; I. Provide oral or written notice of the resolution of the grievance in a manner to ensure ease of understanding; J. Provide for an appeal of a grievance decision if the Member is not satisfied with that decision. K. Provide for continuation of services, if appropriate, while the appeal is pending; L. Provide expedited appeals relating to matters which could place the Member at risk or seriously compromise the Member’s health or well-being; M. Provide written notice of the appeal decision; N. Provide for the right to request a hearing under KRS Chapter 13B; and O. Provide for continuation of services, if appropriate, while the hearing...
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Related to Grievance and Appeal Policies and Procedures

  • Policies and Procedures i) The policies and procedures of the designated employer apply to the employee while working at both sites. ii) Only the designated employer shall have exclusive authority over the employee in regard to discipline, reporting to the College of Nurses of Ontario and/or investigations of family/resident complaints. iii) The designated employer will ensure that the employee is covered by WSIB at all times, regardless of worksite, while in the employ of either home. iv) The designated employer will ensure that the employee is covered by liability insurance at all times, regardless of worksite, while in the employ of either home. v) The designated employer shall have exclusive authority over the employee’s personnel files and health records. These files will be maintained on the site of the designated employer.

  • COMPLIANCE WITH POLICIES AND PROCEDURES During the period that Executive is employed with the Company hereunder, Executive shall adhere to the policies and standards of professionalism set forth in the Company’s Policies and Procedures as they may exist from time to time.

  • Violence Policies and Procedures The Employer agrees to have in place explicit policies and procedures to deal with violence. The policy will address the prevention of violence, the management of violent situations, provision of legal counsel and support to employees who have faced violence. The policies and procedures shall be part of the employee's health and safety policy and written copies shall be provided to each employee. Prior to implementing any changes to these policies, the employer agrees to consult with the Association.

  • Compliance Policies and Procedures To assist the Fund in complying with Rule 38a-1 of the 1940 Act, BBH&Co. represents that it has adopted written policies and procedures reasonably designed to prevent violation of the federal securities laws in fulfilling its obligations under the Agreement and that it has in place a compliance program to monitor its compliance with those policies and procedures. BBH&Co will upon request provide the Fund with information about our compliance program as mutually agreed.

  • GRIEVANCE AND ARBITRATION PROCEDURES 8.01 Any employee(s) or the Union may present a complaint at any time without recourse to the formal written procedure contained herein. Failure to comply with this step, or the manner in which it is complied with shall not interfere with the formal grievance procedure, nor shall this step be subject of preliminary objections in any arbitration hearing. 8.02 At any step in the grievance procedure, including the complaint stage, the employee may be accompanied by his/her employee representative. 8.03 Grievances shall be registered with the Employer as follows: Step No. 1 An employee(s) or the Union on his/her/their behalf or in its own stead may present a grievance in writing to the Director of Care. Such grievance must be presented within ten (10) days of the date of its occurrence or when the employee or the Union reasonably ought to have been aware of this occurrence. The Director of Care shall render a decision in writing in ten (10) days following the day on which the grievance was submitted. If this decision is unsatisfactory to the employee(s) or the Union, Step No. 2 may be followed within ten (10) days. The grievance in writing shall be referred to the Administrator of the Home or designate who shall call a meeting of the Grievance Committee at the request of either party within seven (7) days of the filing of the grievance or such further period as the parties may agree. Within three (3) days following this meeting or within ten (10) days following the submission to the Administrator of the Home or designate if no such meeting is held, the Administrator of the Home or designate shall reply in writing to the employee(s) and the Chairperson of the Grievance Committee. If this decision is unsatisfactory to the employee(s) or the Union, Step No. 3 may be followed within ten (10) days. Within ten (10) days after the decision is given at Step No. 2 the grievance may be referred to the Chief Administrative Officer of the County or designate and the employee accompanied by his/her representative shall meet within ten (10) working days with the Chief Administrative Officer and Committee of Management or their designates. The employee may also be accompanied by a full-time representative of the Union if so desired at this stage. The Employer will render a decision in writing within ten (10) days following such meeting. If the decision is unsatisfactory to the employee(s) or the Union, it may be referred to arbitration. 8.04 A policy grievance may be presented by either the Union or the Employer at Step 2 of the Grievance Procedure. 8.05 Notwithstanding any other provisions of this Article, should the Employer discharge, suspend or discipline an employee or employees, notification by the Employer to such employee or employees shall be made in the presence of a member of the Union. Should the employee(s) or the Union on his/her/their behalf file a grievance against the discharge, suspension or discipline, it shall be reduced to writing and filed within ten (10) days under Step No. 3 of the Grievance Procedure. 8.06 Before any grievance is submitted to arbitration, the parties may meet with a Grievance Mediator in order to attempt to resolve such grievance. The parties may refer any number of outstanding grievances to the Grievance Mediator for possible resolution. Each party shall pay one-half (1/2) of the fees and expenses of the Grievance Mediator. 8.07 When either party requests that a grievance be submitted to arbitration, the grievance shall be submitted to one of the following panel of sole Arbitrators: ▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇ ▇▇▇▇▇ If a grievance has already been submitted to one of the Panel of Arbitrators, then any subsequent grievances shall be submitted to the next Arbitrator on the Panel. In order to accept an appointment, the Arbitrator must agree to render an award within thirty (30) days of the last day of hearing. 8.08 In the event that the parties mutually agree to refer a grievance to a tripartite Arbitration Board, the party requesting arbitration shall advise the other of its nominee to the Arbitration Board. Within ten (10) days thereafter, the other party shall answer, in writing, indicating the name and address of its appointee to the Arbitration Board. The Chair shall be selected from the Panel of Arbitrators set out in paragraph 8.07 above. 8.09 Once appointed, the Arbitration Board or single Arbitrator shall have all the powers set out in Section 50 of the Labour Relations Act including the power to mediate/arbitrate the grievance and to limit evidence and submissions. 8.10 Each party shall pay the costs and expenses of its appointees and the costs and expenses of the Chairperson shall be borne equally by the parties. Arbitration hearings shall be held in the community of the Employer or at such other places as may be agreed upon by the Union and the Employer. 8.11 The Arbitration Board shall not have jurisdiction to amend or add to any of the provisions of this Agreement, or to substitute any new provisions in lieu thereof, nor to give any decision inconsistent with the terms and provisions of this Agreement. 8.12 No person may be appointed as an arbitrator who has been involved in an attempt to negotiate or settle the grievance. 8.13 Any time limit referred to in the Grievance and Arbitration Procedures shall be exclusive of Saturdays, Sundays and holidays observed by the Employer and the days off of the aggrieved employee including vacation, and such limits may be extended with the agreement of both parties.