Services for New Members. The Contractor agrees to make available the full scope of benefits to which a member is entitled immediately upon his or her enrollment.
Services for New Members. The PH-MCO must make available the full scope of benefits to which a Member is entitled from the effective Enrollment date provided by the Department. The PH-MCO must make a best effort to conduct an initial screening of each member’s needs, within 90 days of the effective date of enrollment for all new members, including subsequent attempts if the initial attempt to contact the member is unsuccessful. The PH-MCO must share with DHS or any other MCO serving the member the results of any identification and assessment of that member’s needs to prevent duplication of those activities. The PH-MCO will collaborate with the Department to develop, adopt and disseminate a resource and referral tool. The PH-MCO must use pertinent demographic information about the Recipient, i.e., Special Needs data collected through the EAP or directly indicated to the PH-MCO by the Recipient after Enrollment, upon the new Member's effective Enrollment date in the PH-MCO. If a Special Need is indicated, the PH-MCO must place a Special Needs indicator on the Member's record and must outreach to that Member to identify their Special Need or circumstance. The PH- MCO must assure that the Member’s needs are adequately addressed including the assignment of a Special Needs or Care Management case manager as appropriate. The PH-MCO must comply with access standards as required in Exhibit AAA, as applicable, Provider Network Composition/Service Access and follow the appointment standards described in Exhibit AAA, as applicable, when an appointment is requested by a Member.
Services for New Members. The PH-MCO must make available the full scope of benefits to which a Member is entitled from the effective Enrollment date provided by the Department. The PH-MCO must ensure that pertinent demographic information about the Recipient, i.e., Special Needs data collected through the EAP or directly indicated to the PH-MCO by the Recipient after Enrollment, will be used by the PH-MCO upon the new Member's effective Enrollment date in the PH-MCO. If a Special Need is indicated, the PH-MCO is required to place a Special Needs indicator on the Member's record and must outreach to that Member to identify their Special Need or circumstance. The PH- MCO must assure that the Member’s needs are adequately addressed. The PH-MCO must comply with access standards as required in Exhibit AAA(1), AAA(2), or AAA(3), as applicable, of this Agreement, Provider Network Composition/Service Access and follow the appointment standards described in Exhibit AAA(1), AAA(2), or AAA(3), as applicable, when an appointment is requested by a Member.
Services for New Members. The Contractor must make available the full scope of benefits to which a Member is entitled from the effective enrollment date provided by the Department. Detailed descriptions of those services can be found in the HealthChoices Proposers' Library in the materials describing the MA FFS Program for those services. The Contractor must ensure that pertinent demographic information about the MA Consumer, i.e., Special Needs data collected through the IEAP or directly indicated to the Contractor by the MA Consumer after enrollment, will be used by the Contractor upon the new Member's effective enrollment date in the PH-MCO. If a Special Need is indicated, the Contractor is required to place a Special Needs indicator on the Member's record and must outreach to that Member to identify their Special Need or circumstance. For any Member with a Special Needs indicator, the Contractor must arrange for a health needs assessment within forty-five (45) days; provide results of the same to the assigned PCP; and track and follow-up outcomes to assure the Member's needs are adequately addressed. The Contractor must comply with access standards as required in Section V.S of this Agreement, Provider Network/Services Access and follow the appointment standards described in Section V.S.12 of this Agreement, Appointment Standards, when an appointment is requested by a Member.
