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.
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.
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).
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.
