Appeals and Grievances. The MCP shall have written policies and procedures for an appeal and grievance system for members in compliance with the requirements of OAC rule 5160-26-08.4 and 42 CFR 438 Subpart F and shall include the participation of individuals authorized by the MCP to require corrective action. The MCP is prohibited from delegating the appeal or grievance process to another entity unless approved by ODM. These policies and procedures shall include a process by which members may file grievances and appeals with the MCP, and a process by which members may access the state’s fair hearing system through the Ohio Department of Job and Family Services (ODJFS) Bureau of State Hearings (BSH).
Appears in 15 contracts
Samples: Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan
Appeals and Grievances. The MCP MCOP shall have written policies and procedures for an appeal and grievance system for members members, in compliance with the requirements of OAC rule 5160-2658-08.4 08.4, 42 CFR 422.564, and 42 CFR C.F.R. 438 Subpart F F, and shall include the participation of individuals authorized by the MCP MCOP to require corrective action. The MCP MCOP is prohibited from delegating the appeal or grievance process to another entity unless approved by ODM. These policies and procedures shall include a process by which members may file grievances and appeals with the MCPMCOP, and a process by which members may access the state’s fair hearing system through the Ohio Department of Job and Family Services (ODJFS) Bureau of State Hearings (BSH).
Appears in 10 contracts
Samples: The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan, The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan, The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan
Appeals and Grievances. The MCP shall have written policies and procedures for an appeal and grievance system for members members, in compliance with the requirements of OAC rule 5160-26-08.4 and 42 CFR 438 Subpart F F, and shall include the participation of individuals authorized by the MCP to require corrective action. The MCP is prohibited from delegating the appeal or grievance process to another entity unless approved by ODM. These policies and procedures shall include a process by which members may file grievances and appeals with the MCP, and a process by which members may access the state’s fair hearing system through the Ohio Department of Job and Family Services (ODJFS) Bureau of State Hearings (BSH).
Appears in 3 contracts
Samples: Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan
Appeals and Grievances. The MCP shall have written policies and procedures for an appeal and grievance system for members members, in compliance with the requirements of OAC rule 5160-26-08.4 and 42 CFR C.F.R. 438 Subpart F F, and shall include the participation of individuals authorized by the MCP to require corrective action. The MCP is prohibited from delegating the appeal or grievance process to another entity unless approved by ODM. These policies and procedures shall include a process by which members may file grievances and appeals with the MCP, and a process by which members may access the state’s fair hearing system through the Ohio Department of Job and Family Services (ODJFS) Bureau of State Hearings (BSH).
Appears in 2 contracts
Samples: Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan
Appeals and Grievances. The MCP MCOP shall have written policies and procedures for an appeal and grievance system for members members, in compliance with the requirements of OAC rule 5160-2658-08.4 and 42 CFR C.F.R. 438 Subpart F F, and shall include the participation of individuals authorized by the MCP MCOP to require corrective action. The MCP MCOP is prohibited from delegating the appeal or grievance process to another entity unless approved by ODM. These policies and procedures shall include a process by which members may file grievances and appeals with the MCPMCOP, and a process by which members may access the state’s fair hearing system through the Ohio Department of Job and Family Services (ODJFS) Bureau of State Hearings (BSH).
Appears in 1 contract
Samples: The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan
Appeals and Grievances. The MCP MCOP shall have written policies and procedures for an appeal and grievance system for members members, in compliance with the requirements of OAC rule 5160-26-08.4 5160‐58‐08.4 and 42 CFR C.F.R. 438 Subpart F F, and shall include the participation of individuals authorized by the MCP MCOP to require corrective action. The MCP MCOP is prohibited from delegating the appeal or grievance process to another entity unless approved by ODM. These policies and procedures shall include a process by which members may file grievances and appeals with the MCPMCOP, and a process by which members may access the state’s fair hearing system through the Ohio Department of Job and Family Services (ODJFS) Bureau of State Hearings (BSH).
Appears in 1 contract
Samples: The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan
