Transition of Care. When individuals transition to the CRS contractor from an AACP health plan, children in active treatment (including but not limited to chemotherapy, pregnancy, drug regime or a scheduled procedure) with a CRS non-participating provider shall be allowed to continue receiving treatment from the non-participating provider through the duration of their prescribed treatment.
Transition of Care. The movement of patients made between health care practitioners and/or settings as their condition and care needs change during the course of a chronic or acute illness.
Transition of Care. 34.1. CONTRACTOR shall follow COUNTY’s transition of care policy in accordance with applicable state and federal regulations, MHSUDS IN 18-051: DMC-ODS Transition of Care Policy, and any BHINs issued by DHCS for parity in SUD and mental health benefits subsequent to the effective date of this Agreement (42 C.F.R. § 438.62(b)(1)-(2).)
34.2. Clients shall be allowed to continue receiving covered DMC-ODS services with an out-of- network provider when their assessment determines that, in the absence of continued services, the client would suffer serious detriment to their health or be at risk of hospitalization or institutionalization. DMC-ODS treatment services with the existing provider (out-of-network) provider shall continue for a period of no more than 90 days unless medical necessity requires the services to continue for a longer period of time, not exceeding 12 months. Specific criteria must be met.
Transition of Care. The implementation of Centennial Care will require a transition of care either into or out of the CONTRACTOR’s organization. The CONTRACTOR shall:
(a) within ninety (90) days of the effective date of this Agreement, develop and provide to HSD for review and approval written policies and procedures that addresses the clinical transition issues and transfer of large numbers of Members into or out of its organization. These policies and procedures shall include how the CONTRACTOR proposes to identify Members currently receiving services;
(b) within ninety (90) days of the effective date of this Agreement, develop and provide to HSD a detailed plan for the transition of an individual Member, which includes Member and provider education about the CONTRACTOR and the CONTRACTOR’s process to ensure any existing courses of treatment are revised as necessary;
(c) identify Members and provide necessary data and information to a future CONTRACTOR for Members switching MCOs, either individually or in large numbers, to avoid unnecessary delays in treatment that could be detrimental to the Members;
(d) honor all prior approvals granted by HSD or another MCO for the first sixty (60) calendar days of enrollment or until the CONTRACTOR has made other arrangements for the transition of services. Providers associated with these services shall be reimbursed by the CONTRACTOR. The CONTRACTOR is expected to work with the Member, the TPA, and other State representatives on the re-assessment of transitioning Members within the time periods allowed under this Agreement;
(e) reimburse providers and facilities approved by HSD, if a donor organ becomes available during the first sixty (60) calendar days of enrollment and transplant services were previously approved by HSD or another MCO;
(f) fill prescriptions for drug refills for the first ninety (90) days or until the CONTRACTOR has made other arrangements, for newly enrolled Members who are eligible for the Medicaid prescription drug benefit;
(g) pay for Durable Medical Equipment (DME) costing two thousand dollars ($2,000) or more, approved by the CONTRACTOR but delivered after disenrollment;
(h) be responsible for Covered Services provided to the Member for any month the CONTRACTOR received a capitated payment, even if the Member has lost Medicaid eligibility, provided that if HSD recovers premium payments for any month from the CONTRACTOR as a result of a Member’s loss of eligibility, the CONTRACTOR may recover payments made to p...
Transition of Care. $100 per Calendar Day, per Member AND The value of the services the PHP failed to cover during the applicable transition of care period, as determined by the Department.
Transition of Care. The MCO shall comply with the Department’s transition of care policy to ensure that members transitioning to the MCO from FFS Medicaid or transitioning from one MCO to another have continued access to services if the member, in the absence of continued services, would suffer serious detriment to their health or be at risk of hospitalization or institutionalization. The Department’s transition of care policy can be found at: xxxxx://xxx.xxx.xxxxxxxxx.xxx/publications/p02364.pdf Enrollment continues as long as desired by the eligible member regardless of changes in life situation or condition, until the member voluntarily disenrolls, loses eligibility, or is involuntarily disenrolled according to terms of this contract. The MCO may not discriminate in enrollment and disenrollment activities between individuals on the basis of age, disability, association with a person with a disability, national origin, race, ancestry or ethnic background, color, record of arrest or conviction which is not job-related, religious belief or affiliation, sex or sexual orientation, marital status, military participation, political belief or affiliation, use of legal substance outside of work hours, life situation, condition or need for long-term care or health care services. The MCO shall not discriminate against a member based on income, pay status, or any other factor not applied equally to all members, and shall not base requests for disenrollment on such grounds.
Transition of Care. To ensure that a transition is undertaken in an orderly manner that maximizes Member safety and continuity of care, upon expiration or termination of this Agreement for any reason except for immediate termination, Providers shall (a) continue providing Covered Services to Members through (1) the lesser of the period of active treatment for a chronic or acute medical condition or up to 90 days, (2) the postpartum period for Members in their second or third trimester of pregnancy, or (3) such longer period required by Laws or Program Requirements, and (b) cooperate with Health Plan for the transition of Members to other Participating Providers. The terms and conditions of this Agreement shall apply to any such post expiration or termination activities, provided that if a Provider is capitated, Health Plan shall pay the Provider for such Covered Services at 100 percent of Health Plan’s then current rate schedule for the applicable Benefit Plans. The transition of care provisions in this Agreement shall survive expiration or termination of this Agreement.
Transition of Care. The PO shall comply with the Department’s transition of care policy to ensure that members transitioning to the PO from FFS Medicaid or transitioning from one MCO or PO to another have continued access to services if the member, in the absence of continued services, would suffer serious detriment to their health or be at risk of hospitalization or institutionalization. The Department’s transition of care policy can be found at: xxxxx://xxx.xxx.xxxxxxxxx.xxx/publications/p02364.pdf
Transition of Care. If we terminate or suspend any contract with an In-network Practitioner/Provider from which you are currently receiving care, we will notify you, in writing, within 30 days. We will assist you in locating and transferring to another similarly qualified In-network Practitioner/Provider, if available, for continued In-network benefits. You may elect to continue to receive care from this Out-of-network Practitioner/Provider; however, we will only reimburse for such services in accordance with applicable Out-of-network benefit level, if any, and then subject to Medicare Allowable Charges except when you wish to continue an ongoing course of treatment with the provider for a transitional period. This period shall continue for a time that is sufficient to permit coordinated transition planning consistent with your condition and needs relating to the continuity of the case and will not be less than 30 days. If you are in your third trimester of pregnancy at the time of the provider’s disaffiliation, your transitional period will last through the delivery and will allow for postpartum care. These transitional periods with your provider will not be allowed if the provider’s disaffiliation was for reasons related to medical competence or professional behavior. For transitional periods exceeding 30 days, continued care will be provided only if the provider agrees to accept reimbursement from Presbyterian at the rates applicable prior to the start of the transitional period as payment in full. Additionally, the provider must also agree to adhere to Presbyterian’s quality assurance requirements, to provide necessary medical information related to such care, and to follow Presbyterian’s policies and procedures, including but not limited to procedures regarding referrals, pre-authorization and treatment planning approved by Presbyterian.
Transition of Care. 2.9.4.1 The CONTRACTOR shall actively assist members with chronic or acute medical or behavioral health conditions, members who are receiving long- term care services, and members who are pregnant in transitioning to another provider when a provider currently treating their chronic or acute medical or behavioral health condition, currently providing their long-term care services, or currently providing prenatal services has terminated participation with the CONTRACTOR. For CHOICES members, this assistance shall be provided by the member’s care coordinator/care coordination team.
2.9.4.1.1 Except as provided below regarding members who are in their second or third trimester of pregnancy, the CONTRACTOR shall provide continuation of such provider for up to ninety (90) calendar days or until the member may be reasonably transferred to another provider without disruption of care, whichever is less.
2.9.4.1.2 For members in their second or third trimester of pregnancy, the CONTRACTOR shall allow continued access to the member’s prenatal care provider and any provider currently treating the member’s chronic or acute medical or behavioral health condition or currently providing long-term care services, through the postpartum period.
2.9.4.2 The CONTRACTOR shall actively assist members in transitioning to another provider when there are changes in providers. The CONTRACTOR shall have transition policies that, at a minimum, include the following:
2.9.4.2.1 A schedule which ensures transfer does not create a lapse in service;
2.9.4.2.2 For CHOICES members in Groups 2 and 3, the requirement for a HCBS provider that is no longer willing or able to provide services to a member to cooperate with the member’s care coordinator to facilitate a seamless transition to another HCBS provider (see Section 2.12.
12.1) and to continue to provide services to the member until the member has been transitioned to another HCBS provider, as determined by the CONTRACTOR, or as otherwise directed by the CONTRACTOR (see Section 2.12.12.2);
2.9.4.2.3 A mechanism for timely information exchange (including transfer of the member record);
2.9.4.2.4 A mechanism for assuring confidentiality;
2.9.4.2.5 A mechanism for allowing a member to request and be granted a change of provider;
2.9.4.2.6 An appropriate schedule for transitioning members from one (1) provider to another when there is medical necessity for ongoing care.
2.9.4.2.7 Specific transition language on the following special populatio...
