Department of Justice Xxxx X. Xxxxxxx Student Loan Repayment Program (JRJSLRP) Service Agreement – Secondary Term of Service NAME: In consideration of the student loan repayment incentive for which I may qualify under 34 U.S.C. §10671, such incentive having been offered above and beyond the incentive(s) from which I have already benefitted from in exchange for a term of service that I have fulfilled, I hereby agree as follows:
Office of Justice Programs The Provider must report suspected fraud, waste and abuse to the OAG’s Office of the Inspector General at 000-000-0000.
How to File an Appeal of a Prescription Drug Denial For denials of a prescription drug claim based on our determination that the service was not medically necessary or appropriate, or that the service was experimental or investigational, you may request an appeal without first submitting a request for reconsideration. You or your physician may file a written or verbal prescription drug appeal with our pharmacy benefits manager (PBM). The prescription drug appeal must be submitted to us within one hundred and eighty (180) calendar days of the initial determination letter. You will receive written notification of our determination within thirty (30) calendar days from the receipt of your appeal. How to File an Expedited Appeal Your appeal may require immediate action if a delay in treatment could seriously jeopardize your health or your ability to regain maximum function, or would cause you severe pain. To request an expedited appeal of a denial related to services that have not yet been rendered (a preauthorization review) or for on-going services (a concurrent review), you or your healthcare provider should call: • our Grievance and Appeals Unit; or • our pharmacy benefits manager for a prescription drug appeal. Please see Section 9 for contact information. You will be notified of our decision no later than seventy-two (72) hours after our receipt of the request. You may not request an expedited review of covered healthcare services already received.
COMMISSIONER OF ADMINISTRATION As delegated to Office of State Procurement Print Name: XxXxxx Xxxx Date: 6/19/2020 Signature: Original signed Title: Contracts Specialist Date: 6/22/2020 Attachment A – Work Plan Contractor shall hire, train, and make available qualified personnel to perform and administer vocational rehabilitation services. Contractor shall conduct background checks using primary sources on all personnel authorized to provide direct services or transport persons served under this contract. When transportation is provided for persons served under this contract, Contractor shall maintain current records of driving licenses and satisfactory driving history of drivers. Contractor shall provide for the integrity and security of its information assets including, but not limited to, each automated system, electronic file, database or paper file, by establishing appropriate internal policies and procedures for preserving the integrity and security of the personal information of individuals served. Contractor shall work collaboratively as part of the team with VRS staff in providing services that are part of the person’s served Employment Plan. Contractor shall develop and share detailed written information outlining the procedure for notifying VRS and the person or their guardian regarding their acceptance for services listed in Attachment B, Fee-for-Service Rate Schedule. The written information, at a minimum, should include: (a) start date notification, (b) intake process and location, (c) orientation to the Contractor, (d) service planning and delivery, (e) monitoring of service provided, (f) communication and progress reports, (g) service exit or termination. Contractor shall provide the most effective mode(s) of communication to all populations without charge to VRS or persons served. Contractor shall provide Interpreter services for all services in Attachment B, Fee-for-Service Rate Schedule, and Performance Based Agreement (PBA) for Placement and Retention Services as referenced at xxxxx://xx.xxx/deed/job- seekers/disabilities/partners/. Contractor is responsible for all necessary interpreting costs. Documentation (phone calls, emails, report writing, case notes) time is built into the fee structure and rates, therefore is not billable. VRS expects all documentation be provided in accessible format whenever possible. Attachment B – Fee-for-Service Rate Schedule Contractor: Peace of Mind of Duluth, Inc SWIFT Number: 0000000000 Referral Contact(s) and phone number(s): Xxxxxxx Xxxxx Effective Date: 6/22/2020 Service Title Fee Unit Placement and Retention Services under a Performance Based Agreement (PBA) See Performance Based Agreement (PBA) for Placement and Retention Services as referenced at xxxxx://xx.xxx/deed/job- seekers/disabilities/partners/ Yes No Employment Supports/Job Coaching for Short Term Job Supports $45 Hour Informational Interviews $65 Each Intake (Not Applicable to PBA) $90 Each Internship $18 Hour Job Seeking Skills Training $65 Hour Job Shadowing $65 Hour On-the-Job Evaluation $65 Hour Transportation (Mileage Reimbursement) Current IRS Rate Per Mile Attachment C
REGISTRATION WITH DEPARTMENT OF REVENUE The CONTRACTOR shall complete registration with the Washington State Department of Revenue and be responsible for payment of all taxes due on payments made under this contract.
Grievance Commissioner System This is to confirm the discussion of the parties during collective bargaining that they are committed to encouraging early discussion and resolution of labour relations issues at the local level and seek to resolve grievances in a timely and cost efficient manner. To that end, this is to confirm that pursuant to Article 8, the parties agree that the Employer and Union at individual nursing homes may agree to utilize the following process in order to resolve a particular grievance through the utilization of a joint mediation-arbitration procedure:
Grievance Commissioner The Employer and Union may mutually agree in writing to invoke the Commissioner Process rather than proceed to arbitration as set out in this Collective Agreement. All cases referred to arbitration where an employee has a grievance concerning discipline will only be referred to a Grievance Commissioner if the Employer and the Union agree in writing on all the facts. The parties may also agree to group grievances before a single Grievance Commissioner. A Grievance Commissioner (where more than one, acting in rotation) will set aside such time as may be requested by the Employer and the Union to consider and determine grievances referred to them. A Grievance Commissioner shall have the same powers and be subject to the same limitations as a Board of Arbitration hereunder, save and except as expressly provided in 9.18 to 9.22 hereof.
Department of Health and Human Services An employee notified of a positive controlled substance or alcohol test result may request an independent test of their split sample at the employee’s expense. If the test result is negative, the Employer will reimburse the employee for the cost of the split sample test. An employee who has a positive alcohol test and/or a positive controlled substance test may be subject to disciplinary action, up to and including dismissal, based on the incident that prompted the testing, including a violation of the drug and alcohol free work place rules.
PROFESSIONAL RESPONSIBILITY (APPLIES TO RNS ONLY 19.01 The parties agree that resident care is enhanced if concerns relating to professional practice and workload are resolved in a timely and effective manner, as set out below; In the event that the Home assigns a number of residents or a workload to an individual employee or group of employees, such that she or they have cause to believe that she or they are being asked to perform more work than is consistent with proper resident care, she or they shall:
Department Approval All Marketing Materials must be reviewed and have the approval of the Department prior to distribution. The Contractor understands and agrees that when submitting any Marketing Materials to the Department for review, the Department is required to consult with the Medical Care Advisory Committee established under 42 CFR 431.12 or an advisory committee with similar membership.
