PCP Transfers Sample Clauses

PCP Transfers. The MCO must have written policies and procedures for allowing Medicaid enrollees to select or be assigned to a new PCP when such a change is requested by the enrollee, when a primary care provider is terminated from the MCO, or when a PCP change is ordered as part of the resolution to a formal grievance proceeding. In cases where a PCP has been terminated, the MCO must allow affected enrollees to select other PCPs or make a reassignment within fifteen (15) calendar days of the termination effective date. Enrollees may initiate a PCP change at any time, for any reason. The request can be made in writing or over the phone. MCOs are permitted to limit PCP changes to one (1) time per month. The MCO may initiate a PCP change for a Medicaid enrollee under the following circumstances: 1. The enrollee requires specialized care for an acute or chronic condition, and the enrollee and MCO agree that reassignment to a different PCP is in the enrollee’s interest; 2. The enrollee’s PCP ceases to participate in the MCO’s network; 3. The enrollee’s behavior toward the PCP is disruptive, and the PCP has made all reasonable efforts (three (3) attempts within ninety (90) calendar days) to accommodate the enrollee; or 4. The enrollee has taken legal actions against the PCP.

PCP Transfers. The MCO must have written policies and procedures for allowing Medicaid enrollees to select or be assigned to a new PCP when such a change is requested by the enrollee, when a primary care provider is terminated from the MCO, or when a PCP change is ordered as part of the resolution to a formal grievance proceeding. In cases where a PCP has been terminated, the MCO must allow affected enrollees to select other PCPs or make a reassignment within fifteen (15) calendar days of the termination effective date.

PCP Transfers. The Contractor shall: a. At the Enrollee’s request, allow the Enrollee to change his or her PCP with or without cause. Enrollment with the new PCP shall be effective the next business day; b. Monitor Enrollees’ voluntary changes in PCPs to identify PCPs with higher relative rates of Enrollee disenrollment, and identify and address any opportunities for Provider education, training, quality improvement, or sanction; and c. Annually report to EOHHS on the results of the monitoring efforts described in Section 2.4.E.3.b above and Section 2.7.E.8, and the actions taken by the Contractor. d. Involuntary Changes in PCPs 1) The Contractor shall not involuntarily, or without the Enrollee’s request, transfer an Enrollee from their current PCP to a new PCP because of a) an adverse change in the Enrollee’s health status;

PCP Transfers. The MCO must have written policies and procedures for allowing Medicaid enrollees to select or be assigned to a new PCP when such a change is requested by the enrollee, when a PCP is terminated from the MCO, or when a PCP change is ordered as part of the resolution to a formal grievance proceeding. In cases where a PCP has been terminated, the MCO must allow affected enrollees to select other PCPs or make a reassignment within fifteen (15) calendar days of the termination effective date. Enrollees may initiate a PCP change at any time, for any reason. The request can be made in writing or over the phone. The MCO is permitted to limit PCP changes to one time per month. The MCO may initiate a PCP change for a Medicaid enrollee under the following circumstances: 1. The enrollee moves or there is a change in the placement of a child in xxxxxx care and the assigned PCP location no longer meets the access standards; 2. The enrollee requires specialized care for an acute or chronic condition, and the enrollee and MCO agree that reassignment to a different PCP is in the enrollee’s interest; 3. The enrollee’s PCP ceases to participate in the MCO’s network; 4. The enrollee’s behavior toward the PCP is disruptive, and the PCP has made all reasonable efforts (three (3) attempts within ninety (90) calendar days) to accommodate the enrollee; or 5. The enrollee has taken legal actions against the PCP.

PCP Transfers. The Contractor shall: a. At the Enrollee’s request, allow the Enrollee to change his or her PCP with or without cause. Enrollment with the new PCP shall be effective the next business day; b. Monitor Enrollees’ voluntary changes in PCPs to identify PCPs with higher relative rates of Enrollee disenrollment, and identify and address any opportunities for Provider education, training, quality improvement, or sanction; and c. Annually report to EOHHS on the results of the monitoring efforts described in Section 2.4.E.3.b above and Section 2.7.E.8, and the actions taken by the Contractor. d. Involuntary Changes in PCPs 1) The Contractor shall not involuntarily, or without the Enrollee’s request, transfer an Enrollee from their current PCP to a new PCP because of a) an adverse change in the Enrollee’s health status; b) the Enrollee’s utilization of medical services, including but not limited to the Enrollee making treatment decisions with which a provider, including the PCP, or the Contractor disagrees (such as declining treatment or diagnostic testing); c) missed appointments by the Enrollee; d) the Enrollee’s diminished mental capacity, or e) the Enrollee’s uncooperative or disruptive behavior resulting from his or her special needs (except when the Enrollee’s continued enrollment with the PCP seriously impairs the PCP’s ability to furnish services to either the particular Enrollee or other Enrollees) 2) The Contractor may involuntarily transfer an Enrollee from their current PCP to a new PCP if the Contractor follows all policies and procedures specified by EOHHS relating to such transfer, including but not limited to the following: a) The Contractor shall, and shall require the PCPs to, take all serious and reasonable efforts specified by EOHHS prior to such a transfer; b) The Contractor shall require the PCP to include with any request the PCP makes to the Contractor to transfer an Enrollee the information and supporting documentation specified by EOHHS, including demonstrating that the PCP took the serious and reasonable efforts specified by EOHHS and, despite such efforts, the Enrollee’s continued enrollment with the PCP seriously impairs the PCP’s ability to furnish services to either the particular Enrollee or other Enrollees; c) The Contractor shall provide all EOHHS-specified notices to the Enrollee relating to the request; d) The Enrollee’s new PCP to which the Contractor transfers the Enrollee must be within the access and availability requirements ...

PCP Transfers. The MCO must have written policies and procedures for allowing Medicaid enrollees to select or be assigned to a new PCP when such a change is requested by the enrollee, when a primary care provider is terminated from the MCO, or when a PCP change is ordered as part of the resolution to a formal grievance proceeding. In cases where a PCP has been terminated, the MCO must allow affected members to select other PCPs or make a reassignment within 15 days of the termination effective date. Enrollees may initiate a PCP change at any time, for any reason. The request can be made in writing or over the phone. MCOs are permitted to limit PCP changes to one time per month. The MCO may initiate a PCP change for a Medicaid enrollee under the following circumstances:

PCP Transfers. The Contractor shall: a. At the Enrollee’s request, allow the Enrollee to change his or her PCP with or without cause. Enrollment with the new PCP shall be effective the next business day; b. Monitor Enrollees’ voluntary changes in PCPs to identify PCPs with higher relative rates of Enrollee disenrollment, and identify and address any opportunities for Provider education, training, quality improvement, or sanction; and c. Annually report to EOHHS on the results of the monitoring efforts described in Section 2.4.E.3.b above and Section 2.7.E.8, and the actions taken by the Contractor.

PCP Transfers. The MCO must have written policies and procedures for allowing Medicaid enrollees to select or be assigned to a new PCP when such a change is requested by the enrollee, when a primary care provider is terminated from the MCO, or when a PCP change is ordered as part of the resolution 8 Certified nurse midwives are required to practice in a collaborative relationship with a licensed physician (West Virginia Code §30-15-7). The MCO must ensure compliance with all relevant federal and state regulations related to certified nurse midwives. to a formal grievance proceeding. In cases where a PCP has been terminated, the MCO must allow affected enrollees to select other PCPs or make a reassignment within fifteen (15) calendar days of the termination effective date. Enrollees may initiate a PCP change at any time, for any reason. The request can be made in writing or over the phone. MCOs are permitted to limit PCP changes to one (1) time per month. The MCO may initiate a PCP change for a Medicaid enrollee under the following circumstances: 1. The enrollee requires specialized care for an acute or chronic condition, and the enrollee and MCO agree that reassignment to a different PCP is in the enrollee’s interest; 2. The enrollee’s PCP ceases to participate in the MCO’s network; 3. The enrollee’s behavior toward the PCP is disruptive, and the PCP has made all reasonable efforts (three (3) attempts within ninety (90) calendar days) to accommodate the enrollee; or 4. The enrollee has taken legal actions against the PCP.

PCP Transfers. The MCO must have written policies and procedures for allowing Medicaid and WVCHIP enrollees to select or be assigned to a new PCP when such a change is requested by the enrollee, when a PCP is terminated from the MCO, or when a PCP change is ordered as part of the resolution to a formal grievance proceeding. In cases where a PCP has been terminated, the MCO must allow affected enrollees to select other PCPs or make a reassignment within fifteen (15) calendar days of the termination effective date. Enrollees may initiate a PCP change at any time, for any reason. The request can be made in writing or over the phone. The MCO is permitted to limit PCP changes to one (1) time per month. The MCO may initiate a PCP change for a Medicaid or WVCHIP enrollee under the following circumstances: 8 Certified nurse midwives are required to practice in a collaborative relationship with a licensed physician (West Virginia Code §30-15-7). The MCO must ensure compliance with all relevant federal and state regulations related to certified nurse midwives. 1. The enrollee requires specialized care for an acute or chronic condition, and the enrollee and MCO agree that reassignment to a different PCP is in the enrollee’s interest; 2. The enrollee’s PCP ceases to participate in the MCO’s network; 3. The enrollee’s behavior toward the PCP is disruptive, and the PCP has made all reasonable efforts (three (3) attempts within ninety (90) calendar days) to accommodate the enrollee; or 4. The enrollee has taken legal actions against the PCP.

PCP Transfers. The MCO must have written policies and procedures for allowing Medicaid enrollees to select or be assigned to a new PCP when such a change is requested by the enrollee, when a primary care provider is terminated from the MCO, or when a PCP change is ordered as part of the resolution to a formal grievance proceeding. In cases where a PCP has been terminated, the MCO must allow affected members to select other PCPs or make a reassignment within 15 days of the termination effective date. Enrollees may initiate a PCP change at any time, for any reason. The request can be made in writing or over the phone. MCOs are permitted to limit PCP changes to one time per month. The MCO may initiate a PCP change for a Medicaid enrollee under the following circumstances: 1. The enrollee requires specialized care for an acute or chronic condition, and the enrollee and MCO agree that reassignment to a different PCP is in the enrollee’s interest; 2. The enrollee’s PCP ceases to participate in the MCO’s network; 3. The enrollee’s behavior toward the PCP is disruptive, and the PCP has made all reasonable efforts (three attempts within 90 calendar days) to accommodate the enrollee; or 4. The enrollee has taken legal actions against the PCP.