Access for Rhody Health Options Members with Special Needs Sample Clauses

Access for Rhody Health Options Members with Special Needs. In certain cases, Rhody Health Options members may have an ongoing clinical relationship with a particular specialist who serves as a principal coordinating physician for a member’s special health care needs and who plays a critical role in managing that member’s care on a regular basis throughout the year. Contractor shall have policies and procedures whereby the member is ensured facilitated and timely access to such principal coordinating physician. Where this is the case, Contractor shall require communication and collaboration between the PCP and the specialist serving as the principal coordinating physician. For members with special health care needs determined through an assessment by appropriate health care professionals, consistent with 42 CFR 438.208(c) (2), who need a course of treatment or regular care monitoring, Contractor must have a mechanism in place to allow members to directly access a specialist (for example, through a standing referral or an approved number of visits) as appropriate for the member’s condition and identified needs.
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