Single MCO Entity Provider Sample Clauses
The 'Single MCO Entity Provider' clause establishes that only one managed care organization (MCO) entity will be recognized as the provider for the purposes of the agreement. In practice, this means that all services, obligations, and payments under the contract are attributed to a single, designated MCO, even if that entity operates through affiliates or subsidiaries. This clause helps to streamline administration, clarify responsibility, and prevent confusion or disputes over which entity is accountable for performance under the contract.
Single MCO Entity Provider. For MSC+, if the MCO is a single entity provider in a Rural Area, the MCO must allow Beneficiaries:
1) to choose from at least two Primary Care Providers in the MCO’s Network; and 2) to obtain services from any other Provider when the circumstances allow. [42 CFR §438.52]
Single MCO Entity Provider. If the MCO is a single entity Provider in a Rural Area, the MCO must allow Beneficiaries: 1) to choose from at least two Network Providers; and 2) to obtain services from any other Provider when the circumstances allow pursuant to 42 CFR § 438.52. STATE Enrollment Limitation. The STATE may further limit the number of Enrollees in the MCO if in the STATE or CMS’s judgment, or by MCO request, the MCO is unable to demonstrate a capacity to serve additional Enrollees. Enrollees already enrolled in the MCO shall be given priority to continue that enrollment if the STATE and CMS determine that the MCO does not have the capacity to accept all those seeking enrollment in the MCO’s SNBC product. Enrollee Change of MCO. If multiple MCOs are available, Enrollees may change to a different MCO at any time. Enrollment changes with a new MCO will be effective on the first day of the following month, and subject to the enrollment provisions in this section. Enrollee Change of Primary Care Provider. The Enrollee may change to a different Primary Care Provider within the MCO’s network or Care System every thirty (30) days upon request to the MCO. This section does not apply to Enrollees who are under restriction pursuant to section 8.10. No Random Provider Assignment. In no circumstance shall the MCO randomly assign an Enrollee to a Primary Care Provider upon reenrollment. Choice of Network Provider. The MCO must allow an Enrollee to choose his or her Network Provider to the extent possible and appropriate. Notice to Student Enrollees. MCOs meeting the definition of a closed panel health plan, as defined in Minnesota Statutes, § 62Q.43, subd. 1, shall at least annually notify full-time student Enrollees under the age of twenty-five (25) of their right to change their designated clinics or physicians at least once per month. The MCO may require from the student at least fifteen (15) days’ notice of intent to change his or her designated clinic or physician, and as long as the clinic or physician is part of the MCO’s statewide clinic or physician network.