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. Subject to and upon the terms and conditions of this Agreement, the Parties agree to the following:
Transition of Members. 4.11.4.1 Although Referral, Prior Authorization or Pre-certification are not required, the Contractor may require notification from the current Provider in the following circumstances:
Transition of Members. 4.11.4.1 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, this will include:
Transition of Members. In the event that this Agreement terminates for any reason, Participating Allied Health Provider shall cooperate with and assist HMSA as requested in notifying Members who had received their primary care from, or who had been seen on a regular basis by, Participating Allied Health Provider, and in transitioning such Members to a new PCP or other QUEST participating provider. Participating Allied Health Provider shall provide appropriate medical information, as described in the HMSA QUEST Participating Provider Handbook, to other providers and shall fully cooperate in all respects with other providers to assure maximum health outcomes for the Member.
Transition of Members. In the event of transitioning Members from other Medicaid managed care contractors and their provider, Provider shall work with United and other managed care contractors to ensure quality-driven health outcomes for such Members to the extent required by the State Contract or otherwise required by law. In addition, Members may be immediately transferred to another Provider if the Member’s health or safety is in jeopardy.
Transition of Members. Subject to CMS requirements, upon termination of this Agreement for any reason, WellPoint shall (i) terminate USPG Members' participation under this Agreement and in the Program; and (ii) use its best efforts to transition and transfer USPG Members to USPG or another vendor authorized and approved by USPG.
Transition of Members. Upon either Party’s provision of notice of termination of this Agreement to the other Party, PRACTICE shall cooperate fully with HMO and HMO protocols, if any, in the transfer of Members to other HMO Providers.
