Continuity of Treatment Sample Clauses

Continuity of Treatment. Provider shall cooperate with Health Plan and Subcontractor and provide Covered Persons with continuity of treatment, including coordination of care to the extent required under law and according to the terms of the Agreement, in the event Provider’s participation with Subcontractor terminates during the course of a Covered Person’s treatment by Provider, except in the case of adverse reasons on the part of Provider.
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Continuity of Treatment. Texas HealthSpring will notify the Member within thirty (30) days of any impending termination of a Primary Care Physician from Texas HealthSpring's network who is currently treating the Member. Texas HealthSpring will notify the Member within thirty (30) days of any impending termination of a specialist provider from Texas HealthSpring's network, who is currently treating the Member or has treated the Member within the past six (6) months. If the RPO Provider's contract is terminated for any reason other than medical competence or professional behavior, RPO and RPO Provider shall continue the course of treatment of a Member that began prior to such termination or expiration until the Member can, without medically injurious consequences, be transferred to the care of another Participating Provider. RPO Provider shall be compensated for the aforementioned continued provision of ongoing treatment to a Member who is then receiving Medically Necessary treatment in accordance with the dictates of medical prudence for a special circumstance, such as treatment for a Member who has a disability, acute condition, or life-threatening illness, or is past the 24th week of pregnancy in exchange for continuity of ongoing treatment of a Member then receiving medically necessary treatment in accordance with the dictates of medical prudence. "Special circumstances" means a condition such that the treating physician reasonably believes that discontinuing care by the treating physician or provider could cause harm to the Member. The special circumstance shall be identified by the treating physician, who must request that the Member be permitted to continue treatment under the physician's care. In such cases, RPO will continue to reimburse the physician at no less than at the contract rate for the continued provision of ongoing treatment to a Member and neither RPO nor RPO Provider may seek payment from the Member of any amount for which the Member would not be responsible if the physician were still in Texas HealthSpring's Participating Provider network. RPO Provider shall abide by the determination of the applicable Payor's Member Grievance Procedure, including but not limited to grievance procedures for resolving disputes regarding the necessity for continued treatment, as described in the Texas HealthSpring Member Grievance Procedures.
Sample 1
Continuity of Treatment. 3.1.1 Unless this Agreement terminates for reasons of clinical competence or professional behavior, termination will not release the MCO of its obligation to compensate Provider for the continued care and treatment of any Member who is under Special Circumstances (as defined below). 3.1.2 As used in this section, “Special Circumstances” will mean a Member who has a disability, an acute condition, a life-threatening illness, who is past the 24th week of pregnancy, or who has a condition that Provider reasonably believes could cause harm to the Member if such care or treatment is discontinued. 3.1.3 To be reimbursed for providing continued care and treatment under this section, Provider must identify the Member’s Special Circumstances to the MCO, request that the Member be permitted to continue treatment under Provider’s care and agree not to seek payment from the Member of any amounts for which the Member would not be responsible if this Agreement were not terminated. 3.1.4 Compensation to the Provider will be in accordance with the fee schedule in effect as of the termination date. 3.1.5 Treatment of Special Circumstances as described herein will be governed by the dictates of medical prudence and Medical Necessity. 3.1.6 The requirements of this section will not extend beyond 90 days from the effective date of termination, or beyond 9 months in the case of a Member who at the time of the termination has been diagnosed with a terminal illness; provided, however, the obligation of the MCO for reimbursement to a Member will, for a pregnant Member who at the time of termination is past the 24th week of pregnancy, extend through delivery of the child, immediate postpartum care, and the follow-up check-up within the first 6 weeks of delivery. 3.1.7 In addition to the foregoing, termination will not release the Provider or MCO from liability to others with respect to services rendered to Members, monies paid, or other actions through the date of termination, nor will it relieve Provider of his or her obligation not to bill Members for Covered Services. This section will survive termination of this Agreement for any reason.
Sample 1
Continuity of Treatment. If the Provider leaves the Network, upon the Provider’s request, the insurance carrier or Network is obligated to continue to reimburse the Provider for a period not to exceed ninety (90) days at the contracted rate for care of Covered Individual with a life-threatening condition or an acute condition for which disruption of care would harm the employee; and Disputes concerning continuity of care shall be resolved through the complaint resolution process under §§1305.401-1305.405, TIC, and Subchapter G, Ch. 10, TAC.
Sample 1

Related to Continuity of Treatment

  • Continuity of Supply A Service Order will continue until terminated in accordance with this Agreement. A change to a Service Order will not initiate a new Service Order, or cause the existing Service Order to terminate, unless expressly agreed in writing. In particular, a change to a Service Order that is implemented by the LFC electronically and does not require a physical visit to a site or Interconnection Point will not cause the Service Order to terminate.

  • Continuity of Services A. The Contractor recognizes that the service(s) to be performed under this Contract are vital to the State and must be continued without interruption and that, upon Contract expiration, a successor, either the State or another contractor, may continue them. The Contractor agrees to: Furnish phase-in training; and Exercise its best efforts and cooperation to effect an orderly and efficient transition to a successor. B. The Contractor shall, upon the State's written notice: Furnish phase-in, phase-out services for up to sixty (60) days after this Contract expires; and Negotiate in good faith a plan with a successor to determine the nature and extent of phase-in, phase-out services required. The plan shall specify a training program and a date for transferring responsibilities for each division of work described in the plan, and shall be subject to the State's approval. The Contractor shall provide sufficient experienced personnel during the phase-in, phase-out period to ensure that the services called for by this Contract are maintained at the required level of proficiency. C. The Contractor shall allow as many personnel as practicable to remain on the job to help the successor maintain the continuity and consistency of the services required by this Contract. The Contractor also shall disclose necessary personnel records and allow the successor to conduct on-site interviews with these employees. If selected employees are agreeable to the change, the Contractor shall release them at a mutually agreeable date and negotiate transfer of their earned fringe benefits to the successor. D. The Contractor shall be reimbursed for all reasonable phase-in, phase-out costs (i.e., costs incurred within the agreed period after contract expiration that result from phase-in, phase-out operations).

  • Continuity of Care OMPP is committed to providing continuity of care for members as they transition between various IHCP programs and the Contractor’s enrollment. The Contractor shall have mechanisms in place to ensure the continuity of care and coordination of medically necessary health care services for its Hoosier Healthwise members. The State emphasizes several critically important areas where the Contractor shall address continuity of care. Critical continuity of care areas include, but are not limited to:  Transitions for members receiving HIV, Hepatitis C and/or behavioral health services, especially for those members who have received prior authorization from their previous MCE or through fee-for-service;  Transitions for members who are pregnant;  A member’s transition into the Hoosier Healthwise program from traditional fee-for- service or HIP;  A member’s transition between MCEs, particularly during an inpatient stay;  A member’s transition between IHCP programs, Members exiting the Hoosier Healthwise program to receive excluded services;  A member’s exiting the Hoosier Healthwise program to receive excluded services;  A member’s transition to a new PMP;  A member’s transition to private insurance or Marketplace coverage; and  A member’s transition to no coverage. In situations such as a member or PMP disenrollment, the Contractor shall facilitate care coordination with other MCEs or other PMPs. When receiving members from another MCE or fee-for-service, the Contractor shall honor the previous care authorizations for a minimum of thirty (30) calendar days from the member’s date of enrollment with the Contractor. Contractor shall establish policies and procedures for identifying outstanding prior authorization decisions at the time of the member’s enrollment in their plan. For purposes of clarification, the date of member enrollment for purposes of the prior authorization time frames set forth in this section begin on the date the Contractor receives the member’s fully eligible file from the State. Additionally, when a member transitions to another source of coverage, the Contractor shall be responsible for providing the receiving entity with information on any current service authorizations, utilization data and other applicable clinical information such as disease management, case management or care management notes. This process shall be overseen by the Transition Coordination Manager. The Contractor will be responsible for care coordination after the member has disenrolled from the Contractor whenever the member disenrollment occurs during an inpatient stay. In these cases, the Contractor will remain financially responsible for the hospital DRG payment and any outlier payments (without a capitation payment) until the member is discharged from the hospital or the member’s eligibility in Medicaid terminates. The Contractor shall coordinate discharge plans with the member’s new MCE. See Section 3.7.5 for additional requirements regarding continuity of care for behavioral health services. The Hoosier Healthwise MCE Policies and Procedures Manual describes the Contractor’s continuity and coordination of care responsibilities in more detail.

  • Protection of Private Information If this Agreement requires City to disclose “Private Information” to Contractor within the meaning of San Francisco Administrative Code Chapter 12M, Contractor and subcontractor shall use such information only in accordance with the restrictions stated in Chapter 12M and in this Agreement and only as necessary in performing the Services. Contractor is subject to the enforcement and penalty provisions in Chapter 12M.

  • Emergency Medical Treatment I grant the Releasees permission to authorize emergency medical treatment as they deem appropriate, and agree that such action by the Releasees shall be subject to the terms of this Agreement. I understand and agree that the Releasees assume no responsibility for any injury or damage that might result from such emergency medical treatment.

  • Continuity of Service It shall be the right of all Subscribers to continue receiving Cable Service insofar as their financial and other obligations to the Grantee are honored, and subject to Xxxxxxx’s rights under Section 15.2 of this Franchise.

  • Protection of PFPC PFPC shall be indemnified by the Fund and without liability for any action PFPC takes or does not take in reliance upon directions or advice or Oral Instructions or Written Instructions PFPC receives from or on behalf of the Fund or from counsel and which PFPC believes, in good faith, to be consistent with those directions or advice and Oral Instructions or Written Instructions. Nothing in this section shall be construed so as to impose an obligation upon PFPC (i) to seek such directions or advice or Oral Instructions or Written Instructions, or (ii) to act in accordance with such directions or advice or Oral Instructions or Written Instructions.

  • Security of State Information The Contractor represents and warrants that it has implemented and it shall maintain during the term of this Contract the highest industry standard administrative, technical, and physical safeguards and controls consistent with NIST Special Publication 800-53 (version 3 or higher) and Federal Information Processing Standards Publication 200 and designed to (i) ensure the security and confidentiality of State Data; (ii) protect against any anticipated security threats or hazards to the security or integrity of the State Data; and (iii) protect against unauthorized access to or use of State Data. Such measures shall include at a minimum: (1) access controls on information systems, including controls to authenticate and permit access to State Data only to authorized individuals and controls to prevent the Contractor employees from providing State Data to unauthorized individuals who may seek to obtain this information (whether through fraudulent means or otherwise); (2) industry-standard firewall protection; (3) encryption of electronic State Data while in transit from the Contractor networks to external networks; (4) measures to store in a secure fashion all State Data which shall include multiple levels of authentication; (5) dual control procedures, segregation of duties, and pre-employment criminal background checks for employees with responsibilities for or access to State Data; (6) measures to ensure that the State Data shall not be altered or corrupted without the prior written consent of the State; (7) measures to protect against destruction, loss or damage of State Data due to potential environmental hazards, such as fire and water damage; (8) staff training to implement the information security measures; and (9) monitoring of the security of any portions of the Contractor systems that are used in the provision of the services against intrusion on a twenty-four (24) hour a day basis.

  • Freedom of Information and Protection of Privacy Act Any information provided on this contract may be subject to release under the Freedom of Information and Protection of Privacy Act. The Contractor may be consulted prior to release of any information.

  • Protection of PFPC Trust PFPC Trust shall be indemnified by the Fund and without liability for any action PFPC Trust takes or does not take in reliance upon directions or advice or Oral Instructions or Written Instructions PFPC Trust receives from or on behalf of the Fund or from counsel and which PFPC Trust believes, in good faith, to be consistent with those directions or advice or Oral Instructions or Written Instructions. Nothing in this section shall be construed so as to impose an obligation upon PFPC Trust (i) to seek such directions or advice or Oral Instructions or Written Instructions, or (ii) to act in accordance with such directions or advice or Oral Instructions or Written Instructions.

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