Common use of Grievance and Appeal Procedures Clause in Contracts

Grievance and Appeal Procedures. The Contractor shall establish and maintain a procedure for the receipt and prompt internal resolution of all grievances and appeals in accordance with S.C. Code ▇▇▇. §▇▇-▇▇-▇▇▇ (Supp. 2002) as amended and 42 C.F.R. Section 438.400, et seq. The Contractor's grievance and appeals procedures and any changes thereto must be approved in writing by SCDHHS prior to their implementation and must include at a minimum the requirements set forth herein. The Contractor shall refer all Medicaid MHN program members who are dissatisfied with the Contractor or its subcontractor in any respect to the Contractor's designee authorized to require corrective action. In all cases, where the member has a grievance about treatment by the Contractor, or its subcontractor, the member must exhaust the Contractor's internal grievance/appeal procedures prior to accessing the State’s Fair Hearing process. If the member is grieving a disenrollment issue, the Contractor’s grievance process must be completed in time to permit the disenrollment, if approved, to be effective in accordance with the timeframe specified in 42CFR 438.56(e)(1). If as a result of the grievance process the Contractor approves the disenrollment, the State shall not be required to make a determination.

Grievance and Appeal Procedures. The Contractor shall establish and maintain a procedure for the receipt and prompt internal resolution of all member grievances and appeals in accordance with S.C. Code ▇▇▇. §▇▇-▇▇-▇▇▇ (Supp. 2002, as amended) as amended and 42 C.F.R. CFR Section §438.400, et seq. The Contractor's grievance and appeals appeal procedures and any changes thereto must be approved in writing by SCDHHS prior to their implementation and must include at a minimum the requirements set forth herein. The Contractor shall refer all Medicaid MHN program Program members who are dissatisfied in any respect with the Contractor or its subcontractor in any respect to the Contractor's designee authorized to require corrective action. In all cases, where the member has a grievance about treatment by the Contractor, or its subcontractor, the member must exhaust the Contractor's internal grievance/appeal procedures prior to accessing the State’s Fair Hearing process. If the member is grieving a disenrollment issue, the Contractor’s grievance process must be completed in time to permit the disenrollment, if approved, to be effective in accordance with the timeframe specified in 42CFR 42 CFR §438.56(e)(1). If If, as a result of the grievance process process, the Contractor approves the disenrollment, the State shall not be required to make a determination.