Common use of PCP Request Clause in Contracts

PCP Request. The contractor shall develop policies and procedures, which shall be prior approved by the Department, for allowing a PCP to request reassignment of an enrollee, e.g., for irreconcilable differences, for when an enrollee has taken legal action against the provider, or if an enrollee fails to comply with health care instructions and such non-compliance prevents the provider from safely and/or ethically proceeding with that enrollee's health care services. The contractor shall approve any reassignments and require documentation of the reasons for the request for reassignment. For example, if a PCP requests reassignment of an enrollee for failure to comply with health care instructions, the contractor shall take into consideration whether the enrollee has a physical or developmental disability that may contribute to the noncompliance, and whether the provider has made reasonable efforts to accommodate the enrollee's needs. In the case of DYFS-eligible children, copies of such requests shall be sent to the Division of Youth and Family Services, c/o Medicaid Liaison, PO Box 717, Trenton, NJ 08625-0717.

PCP Request. The contractor shall develop policies and procedures, which shall be prior approved by the Department, for allowing a PCP to request reassignment of an enrollee, e.g., for irreconcilable differences, for when an enrollee has taken legal action against the provider, or if an enrollee fails to comply with health care instructions and such non-compliance prevents the provider from safely and/or ethically proceeding with that enrollee's health care services. The contractor shall approve any reassignments and require documentation of the reasons for the request for reassignment. For example, if a PCP requests reassignment of an enrollee for failure to comply with health care instructions, the contractor shall take into consideration whether the enrollee has a physical or developmental disability that may contribute to the noncompliance, and whether the provider has made reasonable efforts to accommodate the enrollee's needs. In the case of DYFS-eligible children, copies of such requests shall be sent to the Division of Youth and Family Services, c/o Medicaid Liaison, PO Box 717▇▇ ▇▇▇ ▇▇▇, Trenton▇▇▇▇▇▇▇, NJ 08625▇▇ ▇▇▇▇▇-0717▇▇▇▇.

PCP Request. The contractor shall develop policies and procedures, which shall be prior approved by the Department, for allowing a PCP to request reassignment of an enrollee, e.g., for irreconcilable differences, for when an enrollee has taken legal action against the provider, or if an enrollee fails to comply with health care instructions and such non-compliance prevents the provider from safely and/or ethically proceeding with that enrollee's health care services. The contractor shall approve any reassignments and require documentation of the reasons for the request for reassignment. For example, if a PCP requests reassignment of an enrollee for failure to comply with health care instructions, the contractor shall take into consideration whether the enrollee has a physical or developmental disability that may contribute to the noncompliance, and whether the provider has made reasonable efforts to accommodate the enrollee's needs. In the case of DYFS-eligible children, copies of such requests shall be sent to the Division of Youth and Family Services, c/o Medicaid Liaison, PO Box 717B▇▇ ▇▇▇, Trenton▇▇▇▇▇▇▇, NJ 08625▇▇ ▇▇▇▇▇-0717▇▇▇▇.