Member Choice Sample Clauses

Member Choice. Pursuant to 1932 (a)(4), the member can choose to change from the MCO to which they were assigned during the first 90 days of enrollment. At the time a member is assigned, an assignment letter will be generated by the Department, either confirming the pre-selected MCO or assigning the member to an MCO for enrollment. The letter will also include the enrollment broker phone number, information about the Medallion 4.0 smartphone application, a link to the Medallion 4.0 website, and instructions to contact the toll-free managed care helpline number to select an available MCO, or for assistance with questions. At that time, the member may call the enrollment broker to select a different MCO. Members are encouraged to exercise their selection choice. The MCO shall be responsible for generating a plan membership package that includes the membership card, provider directory, and member handbook. A member may elect to change health plans during the first ninety (90) calendar days following the effective date of enrollment for any reason. Any such change of plan shall be effective no later than the first day of the second month after the month in which the member requests disenrollment. This ninety (90) day grace period during which a member may change MCOs without cause applies to the member’s initial period of enrollment. Following their initial ninety (90) day enrollment period, members (except those classified as xxxxxx care or adoption assistance) shall be restricted to their health plan selection until the open enrollment period for their locality, unless dis-enrolled under one of the conditions described in Section 6.2 and pursuant with Section 1932 (a)(4)(A) of Title XIX.
Sample 1
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Member Choice. The Contractor shall ensure Enrolled Members the right to select the Providers of their choice without regard to variations in reimbursement. If a Member enrolls with the Contractor and is already established with a Provider who is not a part of the network, the Contractor shall make every effort to arrange for the Enrolled Member to continue with the same Provider if the Enrolled Member so desires. In this case, the Provider would be requested to meet the same qualifications as other Providers in the network.
Sample 1
Member Choice 
Sample 1

Related to Member Choice

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  • Staffing Committee A. Responsibilities. The Nurse Staffing Committee (“NSC”) shall be responsible for determining the Institute’s staffing plan and resolving complaints raised by nurses regarding the implementation of the plan as well as those activities required of it under RCW 70.41, et seq and its successors.

  • EMPLOYEE-MANAGEMENT ADVISORY COMMITTEE 33.01 (a) An Employee-Management Advisory Committee (EMAC) shall be established within three (3) months of the signing of the Collective Agreement. The Union Representative shall provide the names of up to three (3) elected Employees and the Employer shall provide the names of up to three (3) appointed representatives to sit on the EMAC.

  • JOINT LABOUR MANAGEMENT COMMITTEE 18.01 A Joint Labour Management Committee shall be established to attend to those matters which are of mutual interest. To ensure its effectiveness the Committee shall be separate and apart from the grievance procedure.

  • JOINT LABOR MANAGEMENT COMMITTEE In order to encourage open communication, promote harmonious labor relations, and resolve matters of mutual concern, the parties agree to create a joint labor- management committee. The committee will be governed by the following principles:

  • Executive Management The PH-MCO must include in its Executive Management structure: • A full-time Administrator with authority over the entire operation of the PH-MCO. • A full-time HealthChoices Program Manager to oversee the operation of the Agreement, if different than the Administrator. • A full-time Medical Director who is a current Pennsylvania-licensed physician. The Medical Director must be actively involved in all major clinical program components of the PH-MCO and directly participates in the oversight of the SNU, QM Department and UM Department. The Medical Director and his/her staff/consultant physicians must devote sufficient time to the PH-MCO to provide timely medical decisions, including after-hours consultation, as needed. • A full-time Pharmacy Director who is a current Pennsylvania-licensed pharmacist. The Pharmacy Director oversees the outpatient drug management and serves on the PH-MCO P&T Committee. • A Dental Director who is a current Pennsylvania-licensed Doctor of Dental Medicine or Doctor of Dental Surgery. The Dental Director may be a consultant or employee but must be available at a minimum of 30 hours per week. The Dental Director must be actively involved in all program components related to dental services including, but not limited to, dental provider recruitment strategy, assessment of dental network adequacy, providing oversight and strategic direction in the quality of dental services provided, actively engaged in the development and implementation of quality initiatives, and monitor the performance of the dental benefit manger if dental benefits are subcontracted. A full-time Director of Quality Management who is a Pennsylvania- licensed RN, physician or physician's assistant or is a Certified Professional in Healthcare Quality by the National Association for Healthcare Quality Certified in Healthcare Quality and Management by the American Board of Quality Assurance and Utilization Review Providers. The Director of Quality Management must be located in Pennsylvania and have experience in quality management and quality improvement. Sufficient local staffing under this position must be in place to meet QM Requirements. The primary functions of the Director of Quality Management position are: • Evaluate individual and systemic quality of care • Integrate quality throughout the organization • Implement process improvement • Resolve, track, and trend quality of care complaints • Develop and maintain a credentialed Provider network • A full-time CFO to oversee the budget and accounting systems implemented by the PH-MCO. The CFO must ensure the timeliness and accuracy of all financial reports. The CFO shall devote sufficient time and resources to responsibilities under this Agreement. • A full-time Information Systems Coordinator, who is responsible for the oversight of all information systems issues with the Department. The Information Systems Coordinator must have a good working knowledge of the PH-MCO's entire program and operation, as well as the technical expertise to answer questions related to the operation of the information system. • These full time positions must be solely dedicated to the PA HealthChoices Program.

  • TRANSITION COMMITTEE 8.1.0 A transition committee comprised of the employee representatives and the employer representatives, including the Crown, will be established by January 31, 2016 to address all matters that may arise in the creation of the Trust.

  • Labour Management Committee (a) Where the parties mutually agree that there are matters of mutual concern and interest that would be beneficial if discussed at a Labour-Management Committee Meeting during the term of this Agreement, the following shall apply.

  • Members (a) A Person shall be admitted as a Member and shall become bound by, and shall be deemed to have agreed to be bound by, the terms of this Agreement if such Person purchases or otherwise lawfully acquires any Share, and such Person shall become the Record Holder of such Share, in accordance with the provisions of this Agreement. A Member may be a Class A Member, a Class B Member and or Class C Member, and, in such case, shall have the rights and obligation accorded to the Class A Ordinary Shares with respect to such Class A Ordinary Shares or the rights and obligation accorded to the Class A Preferred Shares with respect to such Class A Preferred Shares, as applicable, the rights and obligations accorded to the Class B Ordinary Shares with respect to such Class B Ordinary Shares and the rights and obligations accorded to the Class C Ordinary Share with respect to such Class C Ordinary Share. A Person may become a Record Holder without the consent or approval of any of the Members and without physical execution of this Agreement. A Person may not become a Member without acquiring a Share.

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