Common use of Transition of Members Clause in Contracts

Transition of Members. 4.11.4.1 Contractors shall identify and facilitate transitions for Members that are moving from one CMO to another or from a CMO to a fee-for service provider and require additional or distinctive assistance during a period of transition. When relinquishing Members, the Contractor shall cooperate with the receiving CMO plan or FFS Medicaid regarding the course of on-going care with a specialist or other Provider. Priority will be given to members who have medical conditions or circumstances such as: · Members who are currently hospitalized. · Pregnancy; women who are high risk and in third trimester, or are within 30 days of their anticipated delivery date · Major organ or tissue transplantation services which are in process, or have been authorized · Chronic illness, which has placed the member in a high-risk category and/or resulted in hospitalization or placement in nursing, or other, facilities, and/or · Members who are in treatment such as Chemotherapy, radiation therapy, or Dialysis. · Members with ongoing needs such as Specialized Durable medical equipment including ventilators and other respiratory assistance equipment · Current Home health services · Medically necessary transportation on a scheduled basis and · Prescription medications requiring prior authorizations · The Contractor will monitor providers to ensure transition of care from one entity to another to include discharge planning as appropriate. Procedures that are scheduled to occur after their new CMO effective date, but that have been authorized by either DCH or the patients original CMO prior to their new CMO effective date will be covered by the patients new CMO for 30 days. · Members that are in ongoing outpatient treatment or that are receiving medication that has been covered by DCH or another CMO prior to their new CMO effective date will be covered by the new CMO for at least 30 days to allow time for clinical review, and if necessary transition of care. The CMO will not be obligated to cover services beyond 30 days, even if the DCH authorization was for a period greater than 30 days.

Transition of Members. 4.11.4.1 Contractors shall identify and facilitate transitions for Members that are moving from one CMO to another or from a CMO to a fee-for service provider and require additional or distinctive assistance during a period of transition. When relinquishing Members, the Contractor shall cooperate with the receiving CMO plan or FFS Medicaid regarding the course of on-going care with a specialist or other Provider. Priority will be given to members who have medical conditions or circumstances such as: · • Members who are currently hospitalized. · • Pregnancy; women who are high risk and in third trimester, or are within 30 days of their anticipated delivery date · • Major organ or tissue transplantation services which are in process, or have been authorized · • Chronic illness, which has placed the member in a high-risk category and/or resulted in hospitalization or placement in nursing, or other, facilities, and/or · • Members who are in treatment such as Chemotherapy, radiation therapy, or Dialysis. · • Members with ongoing needs such as Specialized Durable medical equipment including ventilators and other respiratory assistance equipment · • Current Home health services · • Medically necessary transportation on a scheduled basis and · • Prescription medications requiring prior authorizations · • The Contractor will monitor providers Providers to ensure transition of care from one entity to another to include discharge planning as appropriate. Procedures that are scheduled to occur after their new CMO effective date, but that have been authorized by either DCH or the patients original CMO prior to their new CMO effective date will be covered by the patients new CMO for 30 days. · • Members that are in ongoing outpatient treatment or that are receiving medication that has been covered by DCH or another CMO prior to their new CMO effective date will be covered by the new CMO for at least 30 days to allow time for clinical review, and if necessary transition of care. The CMO will not be obligated to cover services beyond 30 days, even if the DCH authorization was for a period greater than 30 days.

Transition of Members. 4.11.4.1 Contractors shall identify and facilitate transitions for Members that are moving from one CMO to another or from a CMO to a fee-for service provider and require additional or distinctive assistance during a period of transition. When relinquishing Members, the Contractor shall cooperate with the receiving CMO plan or FFS Medicaid regarding the course of on-on- going care with a specialist or other Provider. Priority will be given to members who have medical conditions or circumstances such as: · • Members who are currently hospitalized. · • Pregnancy; women who are high risk and in third trimester, or are within 30 days of their anticipated delivery date · • Major organ or tissue transplantation services which are in process, or have been authorized · • Chronic illness, which has placed the member in a high-risk category and/or resulted in hospitalization or placement in nursing, or other, facilities, and/or · • Members who are in treatment such as Chemotherapy, radiation therapy, or Dialysis. · • Members with ongoing needs such as Specialized Durable medical equipment including ventilators and other respiratory assistance equipment · • Current Home health services · • Medically necessary transportation on a scheduled basis and · • Prescription medications requiring prior authorizations · • The Contractor will monitor providers Providers to ensure transition of care from one entity to another to include discharge planning as appropriate. Procedures that are scheduled to occur after their new CMO effective date, but that have been authorized by either DCH or the patients original CMO prior to their new CMO effective date will be covered by the patients new CMO for 30 days. · • Members that are in ongoing outpatient treatment or that are receiving medication that has been covered by DCH or another CMO prior to their new CMO effective date will be covered by the new CMO for at least 30 days to allow time for clinical review, and if necessary transition of care. The CMO will not be obligated to cover services beyond 30 days, even if the DCH authorization was for a period greater than 30 days.

Transition of Members. 4.11.4.1 Contractors shall identify and facilitate transitions for Members that are moving from one CMO to another or from a CMO to a fee-for service provider and require additional or distinctive assistance during a period of transition. When relinquishing Members, the Contractor shall cooperate with the receiving CMO plan or FFS Medicaid regarding the course of on-going care with a specialist or other Provider. Priority will be given to members who have medical conditions or circumstances such as: · Members who are currently hospitalized. · Pregnancy; women who are high risk and in third trimester, or are within 30 days of their anticipated delivery date · Major organ or tissue transplantation services which are in process, or have been authorized · Chronic illness, which has placed the member in a high-risk category and/or resulted in hospitalization or placement in nursing, or other, facilities, and/or · Members who are in treatment such as Chemotherapy, radiation therapy, or Dialysis. · Members with ongoing needs such as Specialized Durable medical equipment including ventilators and other respiratory assistance equipment · Current Home health services · Medically necessary transportation on a scheduled basis and · Prescription medications requiring prior authorizations · The Contractor will monitor providers Providers to ensure transition of care from one entity to another to include discharge planning as appropriate. Procedures that are scheduled to occur after their new CMO effective date, but that have been authorized by either DCH or the patients original CMO prior to their new CMO effective date will be covered by the patients new CMO for 30 days. · Members that are in ongoing outpatient treatment or that are receiving medication that has been covered by DCH or another CMO prior to their new CMO effective date will be covered by the new CMO for at least 30 days to allow time for clinical review, and if necessary transition of care. The CMO will not be obligated to cover services beyond 30 days, even if the DCH authorization was for a period greater than 30 days.

Transition of Members. 4.11.4.1 Contractors shall identify and facilitate transitions for Members that are moving from one CMO to another or from a CMO to a fee-for service provider and require additional or distinctive assistance during a period of transition. When relinquishing Members, the Contractor shall cooperate with the receiving CMO plan or FFS Medicaid regarding the course of on-going care with a specialist or other Provider. Priority will be given to members who have medical conditions or circumstances such as: · Members who are currently hospitalized. · Pregnancy; women who are high risk and in third trimester, or are within 30 days of their anticipated delivery date · Major organ or tissue transplantation services which are in process, or have been authorized · Chronic illness, which has placed the member in a high-risk category and/or resulted in hospitalization or placement in nursing, or other, facilities, and/or · Members who are in treatment such as Chemotherapy, radiation therapy, or Dialysis. · Members with ongoing needs such as Specialized Durable medical equipment including ventilators and other respiratory assistance equipment · Current Home health services 121 · Medically necessary transportation on a scheduled basis and · Prescription medications requiring prior authorizations · The Contractor will monitor providers Providers to ensure transition of care from one entity to another to include discharge planning as appropriate. Procedures that are scheduled to occur after their new CMO effective date, but that have been authorized by either DCH or the patients original CMO prior to their new CMO effective date will be covered by the patients new CMO for 30 days. · Members that are in ongoing outpatient treatment or that are receiving medication that has been covered by DCH or another CMO prior to their new CMO effective date will be covered by the new CMO for at least 30 days to allow time for clinical review, and if necessary transition of care. The CMO will not be obligated to cover services beyond 30 days, even if the DCH authorization was for a period greater than 30 days.