At Risk Enrollees Requiring Transition Sample Clauses

At Risk Enrollees Requiring Transition. (a) Contractor shall have an evaluation and transition plan in place for the Enrollees of the Exchange with existing health coverage including, but not limited to, those members transferring from Major Risk Medical Insurance BProgram, Pre-Existing Condition Insurance PlanCIP, AIDS Drug Assistance ProgramDAP, or other individuals under active care for complex conditions and who require therapeutic provider and formulary transitions. (b) The evaluation and transition plan will include the following: (i) Identification of In-network providers with appropriate clinical expertise or any alternative therapies including specific drugs when transitioning care; (ii) Clear process to communicate Enrollee’s continued treatment using a specific therapy, specific drug or a specific provider when no equivalent is available in-network; (iii) Advanced notification and understanding of out-of-network provider status for treating and prescribing physicians, with documented cost and quality implications; and (iv) A process to allow incoming Enrollees access to Contractor’s formulary information prior to enrollment.
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At Risk Enrollees Requiring Transition. (a) Contractor shall have an evaluation and transition plan in place for the Enrollees of the Exchange with existing health coverage including, but not limited to, those members transferring from Major Risk Medical Insurance Program, Pre-Existing Condition Insurance Plan, AIDS Drug Assistance Program, or other individuals under active care for complex conditions and who require therapeutic provider and formulary transitions. (b) The evaluation and transition plan will include the following:
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At Risk Enrollees Requiring Transition. (a) Contractor shall have an evaluation and transition plan in place for the Enrollees of the Exchange with existing health coverage including, but not limited to, those members transferring from MRMIB, PCIP, ADAP, or other individuals under active care for complex conditions and who require therapeutic provider and formulary transitions (b) The evaluation and transition plan will include the following: (i) Identification of In-network providers with appropriate clinical expertise or any alternative therapies including specific drugs when transitioning care (ii) Clear process to communicate Enrollee’s continued treatment using a specific therapy, specific drug or a specific provider when no equivalent is available in-network (iii) Advanced notification and understanding of out-of-network provider status for treating and prescribing physicians, with documented cost and quality implications (iv) A process to allow incoming Enrollees access to Contractor’s formulary information prior to enrollment.
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Related to At Risk Enrollees Requiring Transition

  • Contract Transition Upon Contract expiration or termination, the Contractor shall ensure a seamless transfer of Contract responsibilities with any subsequent Contractor necessary to transition the Products and services of the Contract. The incumbent Contractor assumes all expenses related to the contract transition.

  • COMMERCIAL REUSE OF SERVICES The member or user herein agrees not to replicate, duplicate, copy, trade, sell, resell nor exploit for any commercial reason any part, use of, or access to 's sites.

  • Contractor Certification for Contractor Employees Introduction Texas Education Code Chapter 22 requires entities that contract with school districts to provide services to obtain criminal history record information regarding covered employees. Contractors must certify to the district that they have complied. Covered employees with disqualifying criminal histories are prohibited from serving at a school district. Definitions: Covered employees: Employees of a contractor or subcontractor who have or will have continuing duties related to the service to be performed at the District and have or will have direct contact with students. The District will be the final arbiter of what constitutes direct contact with students. Disqualifying criminal history: Any conviction or other criminal history information designated by the District, or one of the following offenses, if at the time of the offense, the victim was under 18 or enrolled in a public school: (a) a felony offense under Title 5, Texas Penal Code; (b) an offense for which a defendant is required to register as a sex offender under Chapter 62, Texas Code of Criminal Procedure; or (c) an equivalent offense under federal law or the laws of another state. I certify that: NONE (Section A) of the employees of Contractor and any subcontractors are covered employees, as defined above. If this box is checked, I further certify that Contractor has taken precautions or imposed conditions to ensure that the employees of Contractor and any subcontractor will not become covered employees. Contractor will maintain these precautions or conditions throughout the time the contracted services are provided. OR SOME (Section B) or all of the employees of Contractor and any subcontractor are covered employees. If this box is checked, I further certify that: (1) Contractor has obtained all required criminal history record information regarding its covered employees. None of the covered employees has a disqualifying criminal history.

  • Detailed Description of Services / Statement of Work Describe fully the services that Contractor will provide, or add and attach Exhibit B to this Agreement.

  • Exceptional Access to Thick Registration Data In case of a registrar failure, deaccreditation, court order, etc. that prompts the temporary or definitive transfer of its domain names to another registrar, at the request of ICANN, Registry Operator will provide ICANN with up-­‐to-­‐date data for the domain names of the losing registrar. The data will be provided in the format specified in Specification 2 for Data Escrow. The file will only contain data related to the domain names of the losing registrar. Registry Operator will provide the data as soon as commercially practicable, but in no event later than five (5) calendar days following ICANN’s request. Unless otherwise agreed by Registry Operator and ICANN, the file will be made available for download by ICANN in the same manner as the data specified in Section 3.1 of this Specification.