Participating Provider Hospital Reporting Requirements. (A) The Contractor shall submit to the Department by May 1 of each year, a list of hospitals with which the Contractor has entered into a Participating Provider agreement. The Contractor shall state on this list any restrictions or limitations to clients receiving all Covered Services at any of the hospitals on the list.
(B) In the event that the Participating Provider agreement between the Contractor and one of the hospitals on the list described in Article 5.3.7
(A) is terminated, the Contractor shall:
(1) notify the Department within two business days of the Contractor having knowledge that the Participating Provider agreement with a hospital will be terminated;
(2) notify CHIP Enrollees living within a 40 mile radius of the hospital within 10 calendar days of the termination effective date;
(3) guarantee access to all Covered Services to Enrollees living with a 40 mile radius of the terminated hospital through whichever of the following dates is later:
(i) the end of the month following the month the Contractor notified the Department;
(ii) the termination date of the Participating Provider agreement between the hospital and the Contractor; or
(iii) the date of discharge if the Enrollee was admitted prior to Article 5.3.7(B)(1)(i) or (ii); and
(4) in the event that there is no other hospital that is a Participating Provider within a 40 mile radius of the terminated hospital, allow Enrollees to obtain Covered Services at any hospital within a 40 mile radius without imposing any requirements for prior authorization or other restrictions that would be different from those applied to contracted hospitals.
(C) Termination of a hospital as a Participating Provider is considered a major change to the Contractor’s network of Participating Providers. The Department will allow Enrollees an opportunity to transfer to another Health Plan.
Participating Provider Hospital Reporting Requirements. (A) The Contractor shall submit to the Department by May 1 of each year, a list of hospitals with which the Contractor has entered into a Participating Provider agreement. The Contractor shall state on this list any restrictions or limitations to clients receiving all Covered Services at any of the hospitals on the list.
(B) In the event that the Participating Provider agreement between the Contractor and one of the hospitals on the list described in Article 5.3.7
(A) is terminated, the Contractor shall:
(1) notify the Department within two business days of the Contractor having knowledge that the Participating Provider agreement with a hospital will be terminated;
(2) notify CHIP Enrollees living within a 40 mile radius of the hospital within 10 calendar days of the termination effective date;
(3) guarantee access to all Covered Services to Enrollees living with a 40 mile radius of the terminated hospital through whichever of the following dates is later:
(i) the end of the month following the month the Contractor notified the Department;
(ii) the termination date of the Participating Provider agreement between the hospital and the Contractor; or
(iii) the date of discharge if the Enrollee was admitted prior to Article
