Internal Grievance Clause Samples
Internal Grievance. 2.10.2.1.1. The ICDS Plan must have a formally structured system in place for addressing Beneficiary Grievances, including Grievances regarding reasonable accommodations and access to services under the ADA. The ICDS Plan must maintain written records of all Grievance activities, and notify CMS and ODM of all internal Grievances. The system must meet the standards specified in OAC rule 5160-58-08.4 and in 42 C.F.R. § 422.564.
2.10.2.1.2. A Beneficiary or authorized representative can file a Grievance. An authorized representative must have the Beneficiary’s written consent to file a Grievance on the Beneficiary’s behalf.
2.10.2.1.3. Grievances may be filed orally or in writing, only with the ICDS Plan, within ninety (90) calendar days of the date that the Beneficiary became aware of the issue.
2.10.2.1.4. The ICDS Plan must acknowledge the receipt of each Grievance to the individual filing the Grievance. Oral acknowledgment is acceptable; however, if the Grievance is filed in writing, written acknowledgment must be made within three (3) working days of receipt of the Grievance.
2.10.2.1.5. The ICDS Plan must ensure that decision makers on Grievances were not involved in previous levels of review or decision making, and are health care professionals with clinical expertise in treating the Beneficiary’s condition for either of the following:
2.10.2.1.5.1. A grievance regarding denial of expedited resolutions of an appeal; or
2.10.2.1.5.2. Any grievance involving clinical issues.
2.10.2.1.6. The ICDS Plan must review and resolve all Grievances as expeditiously as the Beneficiary’s health condition requires. Grievance resolutions including Beneficiary notification must meet the following timeframes:
2.10.2.1.6.1. Within twenty-four (24) hours if Grievance must be expedited pursuant to 42 C.F.R. § 422.564(f); or
2.10.2.1.6.2. Within thirty (30) calendar days of receipt for all other Grievances unless OAC rule 5160-58-08.4 requires less than thirty (30) calendar days.
2.10.2.1.7. At a minimum, the ICDS Plan must provide oral notification to the Beneficiary of a Grievance resolution. However, if the ICDS Plan is unable to speak directly with the Beneficiary and/or the resolution includes information that must be confirmed in writing, the resolution must be provided in writing simultaneously with the ICDS Plan’s decision.
Internal Grievance. Contractor shall establish and maintain a grievance process under which Enrollees may submit their grievance regarding all covered services and benefits to the Contractor. Contractor shall establish and maintain a grievance process approved by DHCS under which enrollees may submit their grievances regarding all benefits and services, pursuant to the ▇▇▇▇-▇▇▇▇▇ Health Care Services Plan Act of 1975, WIC Section 14450 and CCR, Title 22, Section 53260.
Internal Grievance. 2.10.2.1.1. The ICDS Plan must have a formally structured system in place for addressing Beneficiary Grievances, including Grievances regarding reasonable accommodations and access to services under the ADA. The system must meet the standards specified in OAC rule 5160-58-08.4 and in 42 C.F.R. § 422.564 and 42 C.F.R. Part 438, Subpart F. The ICDS Plan must maintain written records of all Grievance activities, and notify CMS and ODM of all internal Grievances.
2.10.2.1.1.1. The Grievance record must include at a minimum the name of the covered person for whom the Grievance was filed; a general description of the reason for the Grievance; the date received; the date of each review or, if applicable, review meeting; and resolution information including date of resolution.
2.10.2.1.1.2. The Grievance record must be accessible to CMS and ODM upon request.
2.10.2.1.1.3. The Grievance system must provide information about Enrollee Grievances and Appeals, including reasonable assistance in completing any forms or other procedural steps, which shall include interpreter services and toll-free numbers with TTY and interpreter capability.
2.10.2.1.2. A Beneficiary or authorized representative can file a Grievance. An authorized representative must have the Beneficiary’s written consent to file a Grievance on the Beneficiary’s behalf.
2.10.2.1.3. The ICDS Plan must acknowledge the receipt of each Grievance to the individual filing the Grievance. Oral acknowledgment is acceptable; however, if the Grievance is filed in writing, written acknowledgment must be made within three (3) working days of receipt of the Grievance.