Common use of Member Continuation of Services Clause in Contracts

Member Continuation of Services. The MCP must allow a new member who is transitioning from FFS to an MCP to receive services from network and out-of-panel providers, if any of the following applies: i. The CFC or Adult Extension member has appointments within the initial month of MCP membership with specialty physicians that were scheduled prior to the effective date; ii. The ABD member 21 years or older has appointments within the initial three months of MCP membership with a primary care provider or specialty physician that were scheduled prior to the effective date of membership; or the ABD member under age 21 or member under 21 with an SSI indicator, may continue with out-of-network physician services for up to 180 days after the date of MCP enrollment unless the MCP has identified the member’s need for care management by the process specified in Appendix K.2.

Member Continuation of Services. The MCP must allow a new member who is transitioning from FFS to an MCP to receive services from network and out-of-panel providers, if any of the following applies: i. The CFC or Adult Extension member has appointments within the initial month of MCP membership with specialty physicians that were scheduled prior to the effective date; ii. The ABD member 21 years or older has appointments within the initial three months of MCP membership with a primary care provider or specialty physician that were scheduled prior to the effective date of membership; or the ABD member under age 21 or member under 21 with an SSI indicator, may continue with out-of-network physician services for up to 180 days after the date of MCP enrollment unless the MCP has identified the member’s need for care management by the process specified in Appendix K.2.the

Member Continuation of Services. The MCP must allow a new member who is transitioning from FFS to an MCP to receive services from network and out-of-panel providers, if any of the following applies: i. The CFC or Adult Extension member has appointments within the initial month of MCP membership with specialty physicians that were scheduled prior to the effective date; ii. The ABD member 21 years or older has appointments within the initial three months of MCP membership with a primary care provider or specialty physician that were scheduled prior to the effective date of membership; or the ABD member under age 21 or member under 21 with an SSI indicator, may continue with out-of-network physician services for up to 180 days after the date of MCP enrollment unless the MCP has identified the member’s need for care management by the process specified in Appendix K.2.has