PRIMARY CARE DENTIST CHANGES Sample Clauses

PRIMARY CARE DENTIST CHANGES. ‌ The PDHP may submit a request to the Agency plan analyst to assign a different primary care dentist to a member whose behavior is disruptive, unruly, abusive, or uncooperative to the extent that his or her membership in the PDHP seriously impairs the organization's ability to furnish services to either the member or other members. The PDHP must provide and maintain documentation of at least one oral and at least one written warning to the member regarding the implications of his or her actions. A written explanation of the reason for changing the primary care dentist must be given to the member. The Agency plan analyst may approve such requests provided the PDHP documents that attempts were made to educate the member regarding his/her rights and responsibilities, assistance which would enable the member to comply was offered through case management, and it has been determined that the member's behavior is not related to the member's medical or behavioral condition. Subsequent requests for a primary care dentist change will be considered by the Agency plan analyst for a member who has been subject to the primary dental provider change process outlined in the above paragraph but continues to exhibit behavior that is disruptive, unruly, abusive, or uncooperative to the extent that his or her membership in the PDHP seriously impairs the organization's ability to furnish services to either the member or other members. Such requests must be submitted at least 60 calendar days prior to the requested effective date. Any submitted request shall contain documentation regarding the provider’s intervention, including any additional contact with the member. The documentation should cite the date, the behavior, to whom and what the consequences of continued behavior was addressed.