Common use of Notice to Enrollees Clause in Contracts

Notice to Enrollees. If the STATE determines there is a Material Modification, the MCO shall provide prior written notification to Enrollees who will be affected by such a Material Modification. The MCO shall submit such notice to the STATE for prior approval. The notice must inform each affected Enrollee that:  One of the Primary Care Providers they have used in the past is no longer available and the Enrollee must choose a new Primary Care Provider from the MCO’s remaining choices; or that the Enrollee has been reassigned from a terminated sole source Provider; or‌‌  One of the major Subcontractors providing a network of Providers, including but not limited to the behavioral health network, pharmacy benefit manager, care system, care coordination/case management entity or dental network will no longer be available in the MCO’s network and that access to these services may require that the Enrollee choose a different provider for these services or be assigned a different care coordinator/case manager. This section does not apply to county Subcontractors providing only care coordination/case management, if the county is choosing to no longer contract with any MCO and the loss of the county as a Subcontractor does not result in a change in any other providers.  The notice shall also inform the Enrollee that the Enrollee has the opportunity to disenroll and change MCOs up to one hundred and twenty (120) days from the date of notification, unless open enrollment occurs within one hundred and twenty (120) days of the date of notification. The MCO shall fully cooperate with the STATE and Local Agency to facilitate a change of MCO for Enrollees affected by the Provider termination. See also section 6.13, Transition Services.‌‌‌‌

Notice to Enrollees. If the STATE determines there is a Material Modification, the MCO shall provide prior written notification to Enrollees who will be affected by such a Material Modification. The MCO shall submit such notice to the STATE for prior approval. The notice must inform each affected Enrollee that:  One of the Primary Care Providers they have used in the past is no longer available and the Enrollee must choose a new Primary Care Provider from the MCO’s remaining choices; or that the Enrollee has been reassigned from a terminated sole source Provider; or‌‌ or  One of the major Subcontractors providing a network of Providers, including but not limited to the behavioral health network, pharmacy benefit manager, care system, care coordination/case management entity or dental network will no longer be available in the MCO’s network and that access to these services may require that the Enrollee choose a different provider for these services or be assigned a different care coordinator/case manager. This section does not apply to county Subcontractors providing only care coordination/case management, if the county is choosing to no longer contract with any MCO and the loss of the county as a Subcontractor does not result in a change in any other providers. providers.‌‌  The notice shall also inform the Enrollee that the Enrollee has the opportunity to disenroll and change MCOs up to one hundred and twenty (120) days from the date of notification, unless open enrollment occurs within one hundred and twenty (120) days of the date of notification. The MCO shall fully cooperate with the STATE and Local Agency to facilitate a change of MCO for Enrollees affected by the Provider termination. See also section 6.13, Transition Services.‌‌‌‌

Notice to Enrollees. If the STATE determines there is a Material Modification, the MCO shall provide prior written notification to Enrollees who will be affected by such a Material Modification. The MCO shall submit such notice to the STATE for prior approval. The notice must inform each affected Enrollee that:  : (a) One of the Primary Care Providers they have used in the past is no longer available available, and the Enrollee must choose a new Primary Care Provider from the MCO’s remaining choices; or that the Enrollee has been reassigned from a terminated sole source Provider; or‌‌  or (b) One of the major Subcontractors subcontractors providing a network of Providers, including but not limited to the behavioral health network, pharmacy benefit manager, care system, care coordination/case management entity or dental network will no longer be available in the MCO’s network and that access to these services may require that the Enrollee choose a different provider for these services or be assigned a different care coordinator/case manager. This section does not apply to county Subcontractors providing only care coordination/case management, if the county is choosing to no longer contract with any MCO and the loss of the county as a Subcontractor does not result in a change in any other providers.  services. (c) The notice shall also inform the Enrollee that the Enrollee has the opportunity to disenroll and change MCOs up to one hundred and twenty (120) days from the date of notification, unless open enrollment occurs within one hundred and twenty (120) days of the date of notificationat any time. The MCO shall fully cooperate with the STATE and Local Agency to facilitate a change of MCO for Enrollees affected by the Provider termination. See also section 6.13Provider Access Changes. The MCO shall not make any substantive changes in its method of Provider access during the term of this Contract, Transition Services.‌‌‌‌unless approved in advance by the STATE. For the purposes of this section, a substantive change in the method of Provider access means a change in the way in which an Enrollee must choose his or her Primary Care Provider (clinic) and his or her physician specialists. Examples of methods of Provider access include but are not limited to: 1) Enrollee has open access to all Primary Care Providers (clinics); 2) Enrollee may self-refer to a physician specialist; 3) Enrollee must choose one Primary Care Provider (clinic); and

Notice to Enrollees. If the STATE determines there is a Material Modification, the MCO shall provide prior written notification to Enrollees who will be affected by such a Material Modification. The MCO shall submit such notice to the STATE for prior approval. The notice must inform each affected Enrollee that:  • One of the Primary Care Providers they have used in the past is no longer available and the Enrollee must choose a new Primary Care Provider from the MCO’s remaining choices; or that the Enrollee has been reassigned from a terminated sole source Provider; or‌‌  or • One of the major Subcontractors providing a network of Providers, including but not limited to the behavioral health network, pharmacy benefit manager, care system, care coordination/case management entity or dental network will no longer be available in the MCO’s network and that access to these services may require that the Enrollee choose a different provider for these services or be assigned a different care coordinator/case manager. This section does not apply to county Subcontractors providing only care coordination/case management, if the county is choosing to no longer contract with any MCO and the loss of the county as a Subcontractor does not result in a change in any other providers.  • The notice shall also inform the Enrollee that the Enrollee has the opportunity to disenroll and under the circumstances in sections 2.106(3) or 2.106(4) to change MCOs up to one hundred and twenty (120) days from the date of notification, unless open enrollment annual health plan selection occurs within one hundred and twenty (120) days of the date of notification. The MCO shall fully cooperate with the STATE and Local Agency to facilitate a change of MCO for Enrollees affected by the Provider termination. See also section 6.13, Transition Services.‌‌‌‌Services.

Notice to Enrollees. If the STATE determines there is a Material Modification, the MCO shall provide prior written notification to Enrollees who will be affected by such a Material Modification. The MCO shall submit such notice to the STATE for prior approval. The notice must inform each affected Enrollee that:  : (a) One of the Primary Care Providers they have used in the past is no longer available and that the Enrollee must choose a new Primary Care Provider from the MCO’s remaining choices; or that the Enrollee has been reassigned from a terminated sole source Provider; or‌‌  or (b) One of the major Subcontractors subcontractors providing a network of Providers, including but not limited to the behavioral health network, pharmacy benefit manager, care system, care coordination/case management entity or dental network will no longer be available in the MCO’s network and that access to these services may require that the Enrollee choose a different provider for these services or be assigned a different care coordinator/case manager. This section does not apply to county Subcontractors subcontractors providing only care coordination/case management, if the county is choosing to no longer contract with any MCO and the loss of the county as a Subcontractor subcontractor does not result in a change in any other providers.  . (c) The notice shall also inform the Enrollee that the Enrollee has the opportunity to disenroll and change MCOs up to one hundred and twenty (120) days from the date of notification, unless open enrollment occurs within one hundred and twenty (120) days of the date of notification. The MCO shall fully cooperate with the STATE and Local Agency to facilitate a change of MCO for Enrollees affected by the Provider termination. See also section 6.13, Transition Services.‌‌‌‌.

Notice to Enrollees. If the STATE determines there is a Material Modification, the MCO shall provide prior written notification to Enrollees who will be affected by such a Material Modification. The MCO shall submit such notice to the STATE for prior approval. The notice must inform each affected Enrollee that:  • One of the Primary Care Providers they have used in the past is no longer available and the Enrollee must choose a new Primary Care Provider from the MCO’s remaining choices; or that the Enrollee has been reassigned from a terminated sole source Provider; or‌‌  or • One of the major Subcontractors providing a network of Providers, including but not limited to the behavioral health network, pharmacy benefit manager, care system, care coordination/case management entity or dental network will no longer be available in the MCO’s network and that access to these services may require that the Enrollee choose a different provider for these services or be assigned a different care coordinator/case manager. This section does not apply to county Subcontractors providing only care coordination/case management, if the county is choosing to no longer contract with any MCO and the loss of the county as a Subcontractor does not result in a change in any other providers.  • The notice shall also inform the Enrollee that the Enrollee has the opportunity to disenroll and under the circumstances in sections 2.104(3) or 2.104(4) to change MCOs up to one hundred and twenty (120) days from the date of notification, unless open enrollment annual health plan selection occurs within one hundred and twenty (120) days of the date of notification. The MCO shall fully cooperate with the STATE and Local Agency to facilitate a change of MCO for Enrollees affected by the Provider termination. See also section 6.13, Transition Services.‌‌‌‌Services.

Notice to Enrollees. If the STATE determines there is a Material Modification, the MCO shall provide prior written notification to Enrollees who will be affected by such a Material Modification. The MCO shall submit such notice to the STATE for prior approval. The notice must inform each affected Enrollee that:  One of the Primary Care Providers they have used in the past is no longer available available, and the Enrollee must choose a new Primary Care Provider from the MCO’s remaining choices; or that the Enrollee has been reassigned from a terminated sole source Provider; or‌‌  or One of the major Subcontractors subcontractors providing a network of Providers, including but not limited to the behavioral health network, pharmacy benefit manager, care system, care coordination/case management entity or dental network will no longer be available in the MCO’s network and that access to these services may require that the Enrollee choose a different provider for these services or be assigned a different care coordinator/case managerservices. This section does not apply to county Subcontractors providing only care coordination/case management, if the county is choosing to no longer contract with any MCO and the loss of the county as a Subcontractor does not result in a change in any other providers.  The notice shall also inform the Enrollee that the Enrollee has the opportunity to disenroll and change MCOs up to one hundred and twenty (120) days from the date of notification, unless open enrollment occurs within one hundred and twenty (120) days of the date of notificationat any time. The MCO shall fully cooperate with the STATE and Local Agency to facilitate a change of MCO for Enrollees affected by the Provider termination. See also section 6.13Provider Access Changes. The MCO shall not make any substantive changes in its method of Provider access during the term of this Contract, Transition Services.‌‌‌‌unless approved in advance by the STATE. For the purposes of this section, a substantive change in the method of Provider access means a change in the way in which an Enrollee must choose his or her Primary Care Provider (clinic) and his or her physician specialists. Examples of methods of Provider access include but are not limited to: 1) Enrollee has open access to all Primary Care Providers (clinics); 2) Enrollee may self-refer to a physician specialist; 3) Enrollee must choose one Primary Care Provider (clinic); and