At Risk Enrollees Requiring Transition Sample Clauses

At Risk Enrollees Requiring Transition. (a) Contractor shall have an evaluation and transition plan in place for the Enrollees of the Exchange with existing health coverage including, but not limited to, those members transferring from Major Risk Medical Insurance Program, Pre-Existing Condition Insurance Plan, AIDS Drug Assistance Program, or other individuals under active care for complex conditions and who require therapeutic provider and formulary transitions. (b) The evaluation and transition plan will include the following: (i) Identification of In-network providers with appropriate clinical expertise or any alternative therapies including specific drugs when transitioning care; (ii) Clear process to communicate Enrollee’s continued treatment using a specific therapy, specific drug or a specific provider when no equivalent is available in-network; (iii) Advanced notification and understanding of out-of-network provider status for treating and prescribing physicians, with documented cost and quality implications; and (iv) A process to allow incoming Enrollees access to Contractor’s formulary information prior to enrollment.
Sample 1
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At Risk Enrollees Requiring Transition. (a) Contractor shall have an evaluation and transition plan in place for the Enrollees of the Exchange with existing health coverage including, but not limited to, those members transferring from MRMIB, PCIP, ADAP, or other individuals under active care for complex conditions and who require therapeutic provider and formulary transitions (b) The evaluation and transition plan will include the following: (i) Identification of In-network providers with appropriate clinical expertise or any alternative therapies including specific drugs when transitioning care (ii) Clear process to communicate Enrollee’s continued treatment using a specific therapy, specific drug or a specific provider when no equivalent is available in-network (iii) Advanced notification and understanding of out-of-network provider status for treating and prescribing physicians, with documented cost and quality implications (iv) A process to allow incoming Enrollees access to Contractor’s formulary information prior to enrollment.
Sample 1
At Risk Enrollees Requiring Transition. (a) Contractor shall have an evaluation and transition plan in place for the Enrollees of the Exchange with existing health coverage including, but not limited to, those members transferring from Major Risk Medical Insurance Program, Pre-Existing Condition Insurance Plan, AIDS Drug Assistance Program, or other individuals under active care for complex conditions and who require therapeutic provider and formulary transitions. (b) The evaluation and transition plan will include the following:
Sample 1

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