Grievances System Sample Clauses

Grievances System a. Contractor shall have written procedures approved in writing by DHS for accepting, processing and responding to all Grievances and Appeals from OHP Members, consistent with the requirements of Exhibit N and OAR 410-141-0260 through 410-141-0266, including Grievances and Appeals related to requests for accommodation in communication or provision of Services for OHP Members with a disability or limited English proficiency. DHS reviews the Contractor’s procedures for compliance with the requirements of Exhibit N and OAR 410-141-0260 through 410-141-0266, as well as any applicable federal requirements, including 42 CFR 438. b. Each time a Covered Service or benefit is denied, terminated, suspended or reduced, or when Contractor authorizes a course of Treatment or Covered Service, but subsequently acts to terminate, discontinue or reduce the course of Treatment or a Covered Service, Contractor shall issue a Notice of Action to the affected OHP Member at least 10 Business Days before the date of the Action, unless there is documentation that the OHP Member had previously agreed to the c. In the event an OHP Member or an OHP Member Representative requests an Administrative Hearing from DHS, Contractor shall comply with the requirements of Exhibit N and OAR 410- 141-0264, Administrative Hearings. d. Contractor shall maintain a log of all OHP Member Grievances and Appeals. The log shall identify the OHP Member, the date of the Grievance, the resolution and the date of resolution. Contractor shall retain Grievance and Appeal logs for 7 (seven) years. This provision shall survive expiration or termination of this Contract. e. Contractor shall submit to DHS a quarterly report summarizing OHP Member Grievances, using the report format in Exhibit N, Attachment 1. f. Contractor and its subcontractors shall cooperate with the DHS’ Client Advisory Services Unit and the AMH Representatives in all of DHS’ activities related to OHP Member Grievances, Appeals, and Administrative Hearings. g. Contractor shall inform OHP Members about the Contractor’s Grievance and Appeal procedures and timeframes, the availability of assistance in the filing process, the toll-free numbers that an OHP Member can use to file a Grievance or Appeal by phone, how to request continuation of benefits (and OHP Member responsibility to pay for the cost of services furnished while an Appeal or Administrative Hearing is pending if the final decision is adverse to the OHP Member), and how to access a Ad...