Adjustments in Service Area or Enrollment a. If Contractor experiences a Material Change, or is engaged in the termination or loss of a Provider or group or affected by other factors which have significant impact on access in that Service Area and which may result in transferring a substantial number of Members to other Providers employed or subcontracted with Contractor, Contractor shall provide OHA with a written plan for transferring the Members and an updated Provider Report, Exhibit G, at least 90 days prior to the date of such action. Contractor shall remain responsible for maintaining sufficient capacity and solvency, and providing all Covered Services through the end of the 90 day period. OHA will not approve a transfer of Members if the Provider’s contract with the transferring Contractor is terminated for reasons related to quality of care, competency, Fraud or other reasons described in OAR 410-141-3080. If Contractor must terminate a Provider or group due to circumstances that could compromise Member care, less than the required notice to OHA may be provided with the approval of OHA.
Adjustments in Service Area or Enrollment a. If Contractor is engaged in the termination or loss of a Provider or group or affected by other factors which have significant impact on access in that Service Area and which may result in transferring a substantial number of Members to other Providers employed or subcontracted with Contractor, Contractor shall provide OHA with a written plan for transferring the Members and an updated DSN Provider Report, Exhibit G, at least 90 days prior to the date of such action.
Adjustments in Service Area or Enrollment. The terms and conditions of Section 13, Exhibit B, Part 4 in the Medicaid Contract are incorporated by reference and have the same force and effect as though they are fully set forth herein. [Exhibit B, Parts 5 through 7 are reserved.] Exhibit B – Statement of Work – Part 8 – Accountability and Transparency of Operations
Adjustments in Service Area or Enrollment a. If RAE reasonably anticipates losing a substantial number of Members from its enrollment, or experiencing a reduction in its network or capacity due to: (i) the occurrence of a Material Change or other significant change; (ii) engaging in the termination or loss of Participating Providers; or (iii) decreased access in RAE’s Service Area, RAE shall notify TCMC at least 120 days, or as soon as reasonably practicable, prior to the date of such anticipated loss or reduction.
Adjustments in Service Area or Enrollment a. If Contractor experiences a Material Change, or is engaged in the termination or loss of a Provider or group or affected by other factors which have significant impact on access in that Service Area and which may result in transferring a substantial number of Members to other Providers employed or subcontracted with Contractor, Contractor shall provide OHA with a written plan for transferring the Members and an updated Provider Report, Exhibit G, at least 90 days prior to the date of such action, notwithstanding the Contract renewal date. Contractor shall remain responsible for maintaining sufficient capacity and solvency, and providing all Coordinated Care Services through the end of the 90-day period.
