Common use of Services for New Members Clause in Contracts

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 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 in cluding 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 Social Determinants of Health assessment 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 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 Social Determinants of Health assessment 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 make a best effort to conduct an initial screening of each member’s '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 '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 Social Determinants of Health assessment 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 '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 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 make a best effort to conduct an initial screening of each memberMember’s needs, within 90 days Days of the effective date of enrollment Enrollment for all new members, including subsequent attempts if the initial attempt to contact the member Member is unsuccessful. The PH-MCO must share with DHS or any other MCO serving the member Member the results of any identification and assessment of that memberMember’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 make any SDOH assessment or referral tool used by the PH-MCO interoperable with the Health Information Exchange and the statewide resource and referral tool, PA Navigate. 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 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 Social Determinants of Health assessment 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 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 Social Determinants of Health assessment 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- 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.