Transition of Care Requirements for Pregnant Women Sample Clauses

Transition of Care Requirements for Pregnant Women. 4.4.16.3.1 In the event a Member entering the CONTRACTOR’s MCO is in her second or third trimester of pregnancy and is receiving medically necessary covered prenatal care services prior to enrollment in the CONTRACTOR’s MCO, the CONTRACTOR shall be responsible for providing continued access to the prenatal care Provider (whether Contract or Non-Contract Provider) through the postpartum period, without any form of prior approval. 4.4.16.3.2 In the event a Member entering the CONTRACTOR’s MCO is in her first trimester of pregnancy and is receiving medically necessary covered prenatal care services prior to enrollment, the CONTRACTOR shall be responsible for the costs of continuation of such medically necessary prenatal care services, including prenatal care and delivery without any form of prior approval and without regard to whether such services are being provided by a Contract or Non-Contract Provider for up to sixty (60) Calendar Days from the Member’s enrollment or until the Member may be reasonably transferred to a Contract Provider without disruption in care, whichever is less. 4.4.16.3.3 If the Member is receiving services from a Contract Provider, the CONTRACTOR shall be responsible for the costs of continuation of medically necessary covered prenatal services from that provider, without any form of prior approval, through the postpartum period. 4.4.16.3.4 If the Member is receiving services from a Non-Contract Provider, the CONTRACTOR shall be responsible for the costs of continuation of medically necessary covered prenatal services, without any form of prior approval, until such time as the CONTRACTOR can reasonably transfer the Member to a Contract Provider without impeding service delivery that might be harmful to the Member’s health in accordance with this Section 4.4.16.3.