Common use of Mainstreaming Clause in Contracts

Mainstreaming. The State considers mainstreaming of Medicaid and WVCHIP beneficiaries into the broader health delivery system to be important. The MCO must accept responsibility for ensuring that network providers do not intentionally segregate Medicaid or WVCHIP enrollees in any way from other persons receiving services. Examples of prohibited practices include, but are not limited to, the following: 1. Denying or not providing to an enrollee any covered service or availability of a facility; 2. Providing to an enrollee any covered service which is different, or is provided in a different manner or at a different time from that provided to other enrollees, other public or private patients or the public at large; 3. Subjecting an enrollee to segregation or separate treatment in any manner related to the receipt of any covered service; and 4. Assigning times or places for the provision of services on the basis of the race, color, creed, religion, age, sex, national origin, ancestry, marital status, sexual preference, income status, program membership or physical or mental disability of the participants to be served. PCPs are not permitted to close their panels to Medicaid and WVCHIP enrollees if they have not closed their panels to other patients (e.g., uninsured, patients with commercial insurance, etc.). Should a PCP close its panel and later decide to begin accepting new patients, the PCP must admit patients on a first come first serve basis including Medicaid and WVCHIP enrollees. However, if a PCP has the maximum of two thousand (2,000) MHT enrollees, the PCP may admit additional, non-Medicaid or WVCHIP patients.

Mainstreaming. The State considers mainstreaming of Medicaid and WVCHIP beneficiaries into the broader health delivery system to be important. The MCO must accept responsibility for ensuring that network providers do not intentionally segregate Medicaid or WVCHIP enrollees in any way from other persons receiving services. Examples of prohibited practices include, but are not limited to, the following: 1. Denying or not providing to an enrollee any covered service or availability of a facility; 2. Providing to an enrollee any covered service which is different, or is provided in a different manner or at a different time from that provided to other enrollees, other public or private patients or the public at large; 3. Subjecting an enrollee to segregation or separate treatment in any manner related to the receipt of any covered service; and 4. Assigning times or places for the provision of services on the basis of the race, color, creed, religion, age, sex, national origin, ancestry, marital status, sexual preference, income status, program membership or physical or mental disability of the participants to be served. PCPs are not permitted to close their panels to Medicaid and WVCHIP enrollees if they have not closed their panels to other patients (e.g., uninsured, patients with commercial insurance, etc.). Should a PCP close its panel and later decide to begin accepting new patients, the PCP must admit patients on a first come first serve basis including Medicaid and WVCHIP enrollees. However, if a PCP has the maximum of two thousand (2,000) MHT enrollees, the PCP may admit additional, non-Medicaid or WVCHIP patients.

Mainstreaming. The State considers mainstreaming of Medicaid and WVCHIP beneficiaries into the broader health delivery system to be important. The MCO must accept responsibility for ensuring that network providers do not intentionally segregate Medicaid or WVCHIP enrollees in any way from other persons receiving services. Examples of prohibited practices include, but are not limited to, the following: 1. Denying or not providing to an enrollee any covered service or availability of a facility; 2. Providing to an enrollee any covered service which is different, or is provided in a different manner or at a different time from that provided to other enrollees, other public or private patients or the public at large; 3. Subjecting an enrollee to segregation or separate treatment in any manner related to the receipt of any covered service; and 4. Assigning times or places for the provision of services on the basis of the race, color, creed, religion, age, sex, national origin, ancestry, marital status, sexual preference, income status, program membership or physical or mental disability of the participants to be served. PCPs are not permitted to close their panels to Medicaid and WVCHIP enrollees if they have not closed their panels to other patients (e.g., uninsured, patients with commercial insurance, etc.). Should a PCP close its panel and later decide to begin accepting new patients, the PCP must admit patients on a first come first serve basis including Medicaid and WVCHIP enrollees. 11 Registered Nurses and Licensed Social Workers that, on behalf of medical homes of children and youth with special heath care needs, facilitate the patient and family engagement necessary for coordinated, ongoing, comprehensive care. However, if a PCP has the maximum of two thousand (2,000) MHT enrollees, the PCP may admit additional, non-Medicaid or WVCHIP patients.