Common use of Change in Enrollment During Hospital Clause in Contracts

Change in Enrollment During Hospital. Inpatient Facility Stay - When an MCP learns of a currently hospitalized member’s intent to disenroll through the CCR or the HIPAA 834, the disenrolling MCP must notify the hospital/inpatient facility and treating providers as well as the enrolling MCP, if applicable, of the change in enrollment. The disenrolling MCP must notify the inpatient facility that it will remain responsible for the inpatient facility charges through the date of discharge; and must notify the treating providers that it will remain responsible for provider charges through the date of disenrollment. The disenrolling MCP shall not request and/or require that a disenrolled member be discharged from the inpatient facility for transfer to another inpatient facility. Should a discharge and transfer to another inpatient facility be medically necessary, the disenrolling MCP must notify the treating providers to work with the enrolling MCP or ODM as applicable to facilitate the discharge, transfer and authorization of services as needed. When the enrolling MCP learns through the disenrolling MCP, through ODM or other means, that a new member who was previously enrolled with another MCP was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the enrolling MCP shall contact the hospital/ inpatient facility. The enrolling MCP shall verify that it is responsible for all medically necessary Medicaid covered services from the effective date of MCP membership, including professional charges related to the inpatient stay; the enrolling MCP must inform the hospital/inpatient facility that the admitting/disenrolling MCP remains responsible for the hospital/inpatient facility charges through the date of discharge. The enrolling MCP shall work with the hospital/inpatient facility to facilitate discharge planning and authorize services as needed. When an MCP learns that a new member who was previously on Medicaid fee- for-service was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the MCP shall notify the hospital/inpatient facility and treating providers that the MCP is responsible for the professional charges effective on the date of enrollment, and shall work to assure that discharge planning provides continuity using MCP-contracted or authorized providers.

Change in Enrollment During Hospital. Inpatient Facility Stay - When an MCP learns of a currently hospitalized member’s intent to disenroll through the CCR or the HIPAA 834, the disenrolling MCP must notify the hospital/inpatient facility and treating providers as well as the enrolling MCP, if applicable, of the change in enrollment. The disenrolling MCP must notify the inpatient facility that it will remain responsible for the inpatient facility charges through the date of discharge; and must notify the treating providers that it will remain responsible for provider charges through the date of disenrollment. The disenrolling MCP shall not request and/or require that a disenrolled member be discharged from the inpatient facility for transfer to another inpatient facility. Should a discharge and transfer to another inpatient facility be medically necessary, the disenrolling MCP must notify the treating providers to work with the enrolling MCP or ODM as applicable to facilitate the discharge, transfer and authorization of services as needed. When the enrolling MCP learns through the disenrolling MCP, through ODM or other means, that a new member who was previously enrolled with another MCP was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the enrolling MCP shall contact the hospital/ inpatient facility. The enrolling MCP shall verify that it is responsible for all medically necessary Medicaid covered services from the effective date of MCP membership, including professional charges related to the inpatient stay; the enrolling MCP must inform the hospital/inpatient facility that the admitting/disenrolling MCP remains responsible for the hospital/inpatient facility charges through the date of discharge. The enrolling MCP shall work with the hospital/inpatient facility to facilitate discharge planning and authorize services as needed. When an MCP learns that a new member who was previously on Medicaid fee- for-service was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the MCP shall notify the hospital/inpatient facility and treating providers that the MCP is responsible for the professional charges effective on the date of enrollment, and shall work to assure that discharge planning provides continuity using MCP-contracted or authorized providers.

Change in Enrollment During Hospital. Inpatient Facility Stay - When an MCP learns of a currently hospitalized member’s intent to disenroll through the CCR or the HIPAA 834, the disenrolling MCP must notify the hospital/inpatient facility and treating providers as well as the enrolling MCP, if applicable, of the change in enrollment. The disenrolling MCP must notify the inpatient facility that it will remain responsible for the inpatient facility charges through the date of discharge; and must notify the treating providers that it will remain responsible for provider charges through the date of disenrollment. The disenrolling MCP shall not request and/or require that a disenrolled member be discharged from the inpatient facility for transfer to another inpatient facility. Should a discharge and transfer to another inpatient facility be medically necessary, the disenrolling MCP must notify the treating providers to work with the enrolling MCP or ODM as applicable to facilitate the discharge, transfer and authorization of services as needed. When the enrolling MCP learns through the disenrolling MCP, through ODM or other means, that a new member who was previously enrolled with another MCP was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the enrolling MCP shall contact the hospital/ inpatient facility. The enrolling MCP shall verify that it is responsible for all medically necessary Medicaid covered services from the effective date of MCP membership, including professional charges related to the inpatient stay; the enrolling MCP must inform the hospital/inpatient facility that the admitting/disenrolling MCP remains responsible for the hospital/inpatient facility charges through the date of discharge. The enrolling MCP shall work with the hospital/inpatient facility to facilitate discharge planning and authorize services as needed. When an MCP learns that a new member who was previously on Medicaid fee- forfee-for- service was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the MCP shall notify the hospital/inpatient facility and treating providers that the MCP is responsible for the professional charges effective on the date of enrollment, and shall work to assure ensure that discharge planning provides continuity using MCP-contracted or authorized providers.

Change in Enrollment During Hospital. Inpatient Facility Stay - When an MCP MCOP learns of a currently hospitalized member’s intent to disenroll through the CCR or the HIPAA 834, the disenrolling MCP MCOP must notify the hospital/inpatient facility and treating providers as well as the enrolling MCPMCOP, if applicable, of the change in enrollment. The disenrolling MCP MCOP must notify the inpatient facility that it will remain responsible for the inpatient facility charges through the date of discharge; and must notify the treating providers that it will remain responsible for provider charges through the date of disenrollment. The disenrolling MCP MCOP shall not request and/or require that a disenrolled member be discharged from the inpatient facility for transfer to another inpatient facility. Should a discharge and transfer to another inpatient facility be medically necessary, the disenrolling MCP MCOP must notify the treating providers to work with the enrolling MCP MCOP or ODM as applicable to facilitate the discharge, transfer and authorization of services as needed. When the enrolling MCP MCOP learns through the disenrolling MCPMCOP, through ODM or other means, that a new member who was previously enrolled with another MCP MCOP was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the enrolling MCP shall MCOP must contact the hospital/ inpatient facility. The enrolling MCP shall MCOP must verify that it is responsible for all medically necessary Medicaid covered services from the effective date of MCP MCOP membership, including professional charges related to the inpatient stay; additionally, the enrolling MCP MCOP must inform the hospital/inpatient facility that the admitting/disenrolling MCP MCOP remains responsible for the hospital/inpatient facility charges through the date of discharge. The enrolling MCP shall MCOP must work with the hospital/inpatient facility to facilitate discharge planning and authorize services as needed. When an MCP MCOP learns that a new member who was previously on Medicaid fee- forfee-for- service was admitted prior to the effective date of enrollment and remains an inpatient on the effective date of enrollment, the MCP shall MCOP must notify the hospital/inpatient facility and treating providers that the MCP MCOP is responsible for the professional charges effective on the date of enrollment, and shall work to assure that discharge planning provides continuity using MCPMCOP-contracted or authorized providers.