AgdaPkt 2005-06-27 - Laserfiche WebLink

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~ /(!--<'¿ Continuity of Care New Members: If your Employer or Group has changed health plans and you were receiving services from a non- Participating Practitioner for a cwrent episode involving an acute, serious or chronic mental health condition, MHN may, if certain other criteria are met, authorize continuing services from your non- Participating Practitioner. In the event MHN authorizes continuity of care services, MHN will allow the Member a reasonable transition period (subject to the benefit limit) to continue his or her course of treatment with the non- Participating Practitioner prior to transferring to another Participating Practitioner and will arrange for the provision of mental health care services on a timely, appropriate, and medically necessary basis from the non- Participating Practitioner. The length of the transition period will take into account the severity of the Member's condition and the amount of time reasonably necessary to effect a safe transfer on a case-by-case basis. Reasonable consideration will be given to the potential clinical effect that a change of practitioner would have on the Member's treatment for the condition. This decision is detennined by MHN, in consultation with the Member and the non- Participating Practitioner. MHN may require a non- Participating Practitioner whose services are continued for a newly covered member to agree in writing to be subject to the same tenns and conditions that are imposed upon Participating Practitioners providing similar services who are not capitated and who are practicing in . the same or a similar geographic area as the non- Participating Practitioner, including, but not limited to, rates, credentialing, hospital privileging, utilization review, peer review and quality assurance requirements, Among other limitations, new member continuity of care services do not apply if you were offered and refused an out of network option by your Employer, or if you had the option to continue with your previous health plan or non- Participating Practitioner and instead voluntarily chose to change health plans. or if the non- Participating Practitioner does riot agree to abide by the tenns and conditions contained in MHN's standard participating provider contract. Members Whose Practitioner's Contract Has Been Terminated or Not Renewed: If you are receiving care for an acute or serious chronic condition and your Participating Practitioner's contract is tenninated or not renewed, you may ca11 MHN at 1-800-227-1060 and request continuing care by :'our Participating Practitioner, provided you are still eligible. In cases involving an acute condition or a serious chronic condition, MHN will arrange for the provision of mental health care services on a timely and appropriate basis from the terminated practitioner for up to 90 days or a longer period if necessary for a safe transfer to another practitioner (subject to the benefit limit) as detennined by MHN in consultation with the tenninated practitioner, consistent with good professional practice. Ì\lHN may require the tenninated practitioner whose services are continued beyond the contract termination date to agree in writing to be subject to the same contractual tenns and conditions that were in effect prior to tennination. This includes, but is not limited to rates, credentialing, hospital privileging, utilization review, peer review, and quality assurance requirements. The payment of co-payments. deductibles, or other cost sharing components by the Member during the period of continuation of care with a tenninated practitioner will be the same co-payments, dedu:tibles, or other cost sharing components that would be paid by the Member when receiving care from a practitioner currently contracting with MHN. 5