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.
Appears in 3 contracts
Samples: Grant Agreement, Grant Agreement, Grant Agreement
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.
Appears in 2 contracts
Samples: Grant Agreement, Grant Agreement
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 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, 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 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 addressedaddressed 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(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.
Appears in 2 contracts
Samples: Grant Agreement, Healthchoices Agreement
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.
Appears in 1 contract
Samples: Healthchoices Agreement
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 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, 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 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 addressedaddressed 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(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.
Appears in 1 contract
Samples: Healthchoices Agreement
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.
Appears in 1 contract
Samples: Healthchoices Agreement