Optional Termination by Enrollee. For Enrollees currently using an MLTSS Provider that changes status from Network Provider to Non-network provider, and (1) If the Enrollee would have to change his or her residential or institutional Network Provider because of the change in Network status with the MCO, that results in disruption in the Enrollee’s residence or employment, (2) Then the Enrollee may request disenrollment from the MCO. (3) This provision does not apply to situations in which an Enrollee is using a DHS-enrolled MLTSS provider that is not contracted with the MCO as a Network Provider, but it does apply if the MCO is changing from an open network provider model to a Network provider model, and the Enrollee’s MLTSS Provider is not in the Network. [42 CFR §438.56(d)(2)(iv)] See also section 3.14.
Appears in 4 contracts
Samples: Special Needs Basiccare Program Services Contract, Special Needs Basiccare Program Services Contract, Contract for Special Needs Basiccare Program Services
Optional Termination by Enrollee. For Enrollees currently using an MLTSS LTSS Provider that changes status from Network Provider to Non-Non- network provider, and
(1) If the Enrollee would have to change his or her residential or institutional Network Provider because of the change in Network status with the MCO, that results in disruption in the Enrollee’s residence or employment,
(2) Then the Enrollee may request disenrollment from the MCO.
(3) This provision does not apply to situations in which an Enrollee is using a DHS-enrolled MLTSS LTSS provider of the types in Appendix 4, that is not contracted with the MCO as a Network Provider, but it does apply if the MCO is changing from an open network provider model to a Network provider model, and the Enrollee’s MLTSS LTSS Provider is not in the Network. [42 CFR §438.56(d)(2)(iv)] See also section 3.143.13.
Appears in 4 contracts
Samples: Contract for Minnesota Senior Health Options and Minnesota Senior Care Plus Services, Contract for Minnesota Senior Health Options and Minnesota Senior Care Plus Services, Contract for Minnesota Senior Health Options and Minnesota Senior Care Plus Services
Optional Termination by Enrollee. For Enrollees currently using an MLTSS Provider that changes status from Network Provider to Non-network provider, and
(1) If the Enrollee would have to change his or her residential or institutional Network Provider because of the change in Network status with the MCO, that results in disruption in the Enrollee’s residence or employment,
(2) Then the Enrollee may request disenrollment from the MCO.
(3) This provision does not apply to situations in which an Enrollee is using a DHS-enrolled MLTSS provider of the types in Appendix 4, that is not contracted with the MCO as a Network Provider, but it does apply if the MCO is changing from an open network provider model to a Network provider model, and the Enrollee’s MLTSS Provider is not in the Network. [42 CFR §438.56(d)(2)(iv)] See also section 3.14.3.13.
Appears in 1 contract
Samples: Contract for Minnesota Senior Health Options and Minnesota Senior Care Plus Services
