Common use of Health Care Professional Hearings Clause in Contracts

Health Care Professional Hearings. a) A health care professional that has been notified of his or her proposed termination must be allowed a hearing. The procedures for this hearing must meet the following standards: i) The hearing panel shall be comprised of at least three persons appointed by the Contractor. At least one person on such panel shall be a clinical peer in the same discipline and the same or similar specialty as the health care professional under review. The hearing panel may consist of more than three persons, provided however that the number of clinical peers on such panel shall constitute one-third or more of the total membership of the panel. ii) The hearing panel shall render a decision on the proposed action in a timely manner. Such decision shall include reinstatement of the health care professional by the Contractor, provisional reinstatement subject to conditions set forth by the Contractor or termination of the health care professional. Such decision shall be provided in writing to the health care professional. iii) A decision by the hearing panel to terminate a health care professional shall be effective not less than thirty (30) days after the receipt by the health care professional of the hearing panel's decision. Notwithstanding the termination of a health care professional for cause or pursuant to a hearing, the Contractor shall permit an Enrollee to continue an on-going course of treatment for a transition period of up to ninety (90) days, and post-partum care, subject to the provider’s agreement, pursuant to PHL § 4403(6)(e). iv) In no event shall termination be effective earlier than sixty (60) days from the receipt of the notice of termination.

Appears in 1 contract

Samples: Primary Care Partial Capitation Provider (Pcpcp) Medicaid Managed Care Model Contract

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Health Care Professional Hearings. a) A health care professional that has been notified of his or her proposed termination must be allowed a hearing. The procedures for this hearing must meet the following standards: i) The hearing panel shall be comprised of at least three persons appointed by the Contractor. At least one person on such panel shall be a clinical peer in the same discipline and the same or similar specialty as the health care professional under review. The hearing panel may consist of more than three persons, provided however however, that the number of clinical peers on such panel shall constitute one-third or more of the total membership of the panel. ii) The hearing panel shall render a decision on the proposed action in a timely manner. Such decision shall include reinstatement of the health care professional by the Contractor, provisional reinstatement subject to conditions set forth by the Contractor or termination of the health care professional. Such decision shall be provided in writing to the health care professional. iii) A decision by the hearing panel to terminate a health care professional shall be effective not less than thirty (30) days after the receipt by the health care professional of the hearing panel's decision. Notwithstanding the termination of a health care professional for cause or pursuant to a hearing, the Contractor shall permit an Enrollee to continue an on-going course of treatment for a transition period of up to ninety (90) days, and post-partum care, subject to the provider’s 's agreement, pursuant to PHL § Section 4403(6)(e). iv) In no event shall termination be effective earlier than sixty (60) days from the receipt of the notice of termination.

Appears in 1 contract

Samples: Medicaid Managed Care Agreement (Amerigroup Corp)

Health Care Professional Hearings. a) A health care professional that has been notified of his or her proposed termination must be allowed a hearing. The procedures for this hearing must meet the following standards: i) The hearing panel shall be comprised of at least three persons appointed by the Contractor. At least one person on such panel shall be a a. clinical peer in the same discipline and the same or similar specialty as the health care professional under review. The hearing panel may consist of more than three persons, provided however however, that the number of clinical peers on such panel shall constitute one-third or more of the total membership of the panel. ii) The hearing panel shall render a decision on the proposed action in a timely manner. Such decision shall include reinstatement of the health care professional by the Contractor, provisional reinstatement subject to conditions set forth by the Contractor or termination of the health care professional. Such decision shall be provided in writing to the health care professional. iii) A decision by the hearing panel to terminate a health care professional shall be effective not less than thirty (30) days after the receipt by the health care professional of the hearing panel's decision. Notwithstanding the termination of a health care professional for cause or pursuant to a hearing, the Contractor shall permit an Enrollee to continue an on-going course of treatment for a transition period of up to ninety (90) days, and post-partum care, subject to the provider’s 's agreement, pursuant to PHL § 4403(6)(e). iv) In no event shall termination be effective earlier than sixty (60) days from the receipt of the notice of termination.

Appears in 1 contract

Samples: Medicaid Managed Care Contract (Wellcare Health Plans, Inc.)

Health Care Professional Hearings. a) A health care professional that has been notified of his or her proposed termination must be allowed a hearing. The procedures for this hearing must meet the following standards: ia) The hearing panel shall be comprised of at least three persons appointed by the Contractor. At least one person on such panel shall be a clinical peer in the same discipline and the same or similar specialty as the health care professional under review. The hearing panel may consist of more than three persons, provided however that the number of clinical peers on such panel shall constitute one-third or more of the total membership of the panel. iib) The hearing panel shall render a decision on the proposed action in a timely manner. Such decision shall include reinstatement of the health care professional by the Contractor, provisional reinstatement subject to conditions set forth by the Contractor or termination of the health care professional. Such decision shall be provided in writing to the health care professional. iiic) A decision by the hearing panel to terminate a health care professional shall be effective not less than thirty (30) days after the receipt by the health care professional of the hearing panel's decision. Notwithstanding the termination of a health care professional for cause or pursuant to a hearing, the Contractor a plan shall permit an Enrollee to continue an on-going course of treatment for a transition period of up to ninety (90) days, and post-partum care, subject to the provider’s provider agreement, pursuant to PHL § 4403(6)(eSection 4406(6)(e). ivd) In no event shall termination be effective earlier than sixty (60) days from the receipt of the notice of termination.

Appears in 1 contract

Samples: Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.)

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Health Care Professional Hearings. a) A health care professional that has been notified of his or her proposed termination must be allowed a hearing. The procedures for this hearing must meet the following standards: i) The hearing HEARING panel shall be comprised of at least three persons appointed by the Contractor. At least one person on such panel shall be a clinical peer in the same discipline and AND the same or similar specialty as the health care professional under UNDER review. The hearing panel may consist of more than three persons, provided however that the number NUMBER of clinical peers on such panel shall constitute one-third or more of the total membership of the panel. iib) The hearing panel HEARING PANEL shall render a decision on DECISION ON the proposed PROPOSED action in a timely TIMELY manner. Such decision shall include reinstatement of the health care professional by the Contractor, provisional reinstatement subject to conditions set forth by the Contractor or termination of the health care professional. Such decision shall be provided in writing to the health care professional. iiic) A decision by the hearing panel to terminate a health care professional shall be effective not less than thirty (303O) days after the receipt by the health care professional of the hearing panel's decision. Notwithstanding the termination of a health care professional for cause or pursuant to a hearing, the Contractor a plan shall permit an Enrollee to continue an on-going course of treatment for a transition period of up to ninety (90) days, and post-partum postpartum care, subject to the provider’s provider agreement, pursuant to PHL § 4403(6)(eSection 4406(6)(e). ivd) In no event shall termination be effective earlier than sixty (60) days from the receipt of the notice of termination.

Appears in 1 contract

Samples: Medicaid Managed Care Model Contract (Amerigroup Corp)

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