Common use of Transitioning Members between Dental Plans Clause in Contracts

Transitioning Members between Dental Plans. It may be necessary to transition a member between Dental Plans for a variety of reasons. The Contractor will have written policies and procedures for transferring relevant patient information in an efficient manner, including medical records and other pertinent materials, when transitioning a member to or from another Dental Plan. The Contractor will transfer this information at no cost to the member. The Contractor will also transfer this information at no cost to the member in instances where the member had received Covered Services from a participating network provider who is no longer in the provider network and became a Non- Participating Provider. The Contractor may make a reasonable charge to a member who requests his or her own personal copy of a medical record, not to exceed limits established in the Rhode Island Department of Health Rules and Regulations for the Licensure and Discipline of Physician (R5-37-MD/DO). The Contractor agrees to have in effect a transition of care policy to ensure continued access to services during a transition of a member to a new MCO when in the absence of continued services, the member would suffer serious detriment to either health or be at risk of hospitalization or institutionalization. Contractor agrees to provide care plan and associated documentation to new MCO in mutually agreed upon data fields and file format per EOHHS’ discretion and request. This policy must include: • Access to services consistent with the access the member previously had, and the member is permitted to retain their current provider for a period of one- hundred and eighty (180) days if that provider is not in the Contractor’s network; • Referrals to appropriate providers that are in the network; • Fully and timely compliance with requests for historical utilization data from the new MCO in compliance with Federal and State law; and • Any other necessary procedures as specified by EOHHS to ensure continued access to services to prevent serious detriment to the member's health or reduce the risk of hospitalization or institutionalization.

Transitioning Members between Dental Plans. It may be necessary to transition a member between Dental Plans for a variety of reasons. The Contractor will have written policies and procedures for transferring relevant patient information in an efficient manner, including medical records and other pertinent materials, when transitioning a member to or from another Dental Plan. The Contractor will transfer this information at no cost to the member. The Contractor will also transfer this information at no cost to the member in instances where the member had received Covered Services from a participating network provider who is no longer in the provider network and became a Non- Non-Participating Provider. The Contractor may make a reasonable charge to a member who requests his or her own personal copy of a medical record, not to exceed limits established in the Rhode Island Department of Health Rules and Regulations for the Licensure and Discipline of Physician (R5-37-MD/DO). The Contractor agrees to have in effect a transition of care policy to ensure continued access to services during a transition of a member to a new MCO when in the absence of continued services, the member would suffer serious detriment to either health or be at risk of hospitalization or institutionalization. Contractor agrees to provide care plan and associated documentation to new MCO in mutually agreed upon data fields and file format per EOHHS’ discretion and request. This policy must include: • Access to services consistent with the access the member previously had, and the member is permitted to retain their current provider for a period of one- hundred and eighty (180) days if that provider is not in the Contractor’s network; • Referrals to appropriate providers that are in the network; • Fully and timely compliance with requests for historical utilization data from the new MCO in compliance with Federal and State law; and • Any other necessary procedures as specified by EOHHS to ensure continued access to services to prevent serious detriment to the member's health or reduce the risk of hospitalization or institutionalization.

Transitioning Members between Dental Plans. It may be necessary to transition a member between Dental Plans for a variety of reasons. The Contractor will have written policies and procedures for transferring relevant patient information in an efficient manner, including medical records and other pertinent materials, when transitioning a member to or from another Dental Plan. The Contractor will transfer this information at no cost to the member. The Contractor will also transfer this information at no cost to the member in instances where the member had received Covered Services from a participating network provider who is no longer in the provider network and became a Non- Non-Participating Provider. The Contractor may make a reasonable charge to a member who requests his or her own personal copy of a medical record, not to exceed limits established in the Rhode Island Department of Health Rules and Regulations for the Licensure and Discipline of Physician (R5-37-MD/DO). The Contractor agrees to have in effect a transition of care policy to ensure continued access to services during a transition of a member to a new MCO when in the absence of continued services, the member would suffer serious detriment to either health or be at risk of hospitalization or institutionalization. Contractor agrees to provide care plan and associated documentation to new MCO in mutually agreed upon data fields and file format per EOHHS’ discretion and request. This policy must include: • Access to services consistent with the access the member previously had, and the member is permitted to retain their current provider for a period of one- one-hundred and eighty (180) days if that provider is not in the Contractor’s network; • Referrals to appropriate providers that are in the network; • Fully and timely compliance with requests for historical utilization data from the new MCO in compliance with Federal and State law; and • Any other necessary procedures as specified by EOHHS to ensure continued access to services to prevent serious detriment to the member's health or reduce the risk of hospitalization or institutionalization.