What is Leave of Absence Policy

Tufts Health Plan’s policy requires the provider to notify Tufts Health Plan when they are going on a leave of absence (LOA) for longer than 60 days. At a minimum, this notification must include the dates and the general reason for the LOA (sabbatical, medical reason, etc.). Providers must notify Tufts Health Plan of a pending LOA as soon as possible.

Providers taking a leave of absence must arrange for coverage by another participating provider in the Tufts Health Plan network. All covering arrangements must be acceptable to Tufts Health Plan.

Arrangements for coverage by a non-participating provider (i.e., locum tenens) may be considered. These arrangements must have Tufts Health Plan’s prior approval and must be consistent with established policies and procedures.

** If the leave of absence is scheduled for six months or less, Tufts Health Plan will confirm the conclusion of the LOA. If the LOA is concluded within 6 months, the provider’s LOA status will be removed and will reflect his or her prior status prior.

** If the leave of absence is scheduled for longer than six months, Tufts Health Plan reserves the right to terminate the provider from the network based upon continuity of care issues. In addition, if a provider’s recredentialing is due during the LOA and the physician does not complete his/her recredentialing materials, Tufts Health Plan reserves the right to terminate the provider from the network based on contractual noncompliance.

Temporary Transfer of Responsibility

The Provider Agreement obligates Tufts Medicare Preferred HMO PCPs to establish and maintain 24-hour, 7-day-a-week coverage. However, personal illness, sabbatical or maternity leave are examples of situations in which briefly withdrawing from your practice and temporary transfer of this responsibility may be necessary.

If the intended interruption will exceed 60 days, Tufts Health Plan requires the PCP to provide written notice to the Tufts Health Plan’s Provider Information Department. At a minimum, this notification must include the dates and general reasons for the temporary transfer of responsibility. Tufts Health Plan may then close the panel, since absence beyond two months does not allow for direct patient management.