Common use of 01 General Clause in Contracts

01 General. The Contractor must agree to make available the comprehensive benefit package to members covered under this Agreement and do so with a defined population health approach. A population health approach seeks to maintain and improve the health status of the entire population while systematically identifying those subpopulations with complex needs and implementing strategies to improve their health status and reduce health inequities among population groups. This includes the emphasis on transition to value-based payment arrangements with Accountable Entities, effective communication, meaningful analytic capacity and metrics, integrations of care across disciplines as appropriate, recognition of and strategies to address social determinants of health, care coordination, care management, and others. This should include approaches to such components as: • Measuring population health status and outcomes, including sub-groups within the population • Identifying baseline measures and targets for health improvement • Identifying determinants of health outcomes and the identification of strategies for targeted interventions • How such strategies integrate required components of this procurement and other Bidder developed initiatives combine to represent a comprehensive approach to population health The comprehensive benefit package includes Medically Necessary inpatient and outpatient hospital services, physician/provider services, behavioral health services (a continuum of care including mental health and substance use services to individuals with SPMI and cognitive limitations), family planning services, prescription drugs, laboratory, radiology and other diagnostic services, and preventive care. The defining core values driving service delivery are: • Population Health • Consumer-focused services • A holistic approach to health care and wellness • Independence in the community • Access to primary and specialty care when and where needed • Respect and dignity of the individual The guiding principles for service delivery are: • Flexible options that match services with individual needs, both medical and social • The establishment of a medical home that supports primary and preventive care • A screening and assessment process that is coordinated and encompassing • A focus on consumer self-management through education, community supports, and care coordination • Maximum, creative, and effective use of existing infrastructure • Methods for ensuring cost predictability • Responsible stewardship of public dollars The comprehensive benefit package does not include all services to which this group is entitled. EOHHS will continue to offer a schedule of out-of-plan benefits that the Contractor agrees to coordinate for their members. The Contractor is not responsible to deliver or reimburse for these services. Reimbursement for any out of plan benefits will be the responsibility of Fee for Service RI Medicaid. ATTACHMENT A of this Agreement presents the full schedule of in-plan benefits contained in the comprehensive benefit package. The Contractor is authorized to offer alternatives to Medicaid State Plan services where services in an alternative setting would be more cost effective or efficient and is consistent with the best interests and wishes of the member. ATTACHMENT B of this Attachment presents the schedule of out-of-plan benefits. The Contractor agrees to assist with the co-ordination of these services for those members who utilize them. ATTACHMENT C of this Attachment presents a schedule of non-covered services. The Contractor will provide thirty (30) days of nursing home services as medically and/or functionally necessary for the member, inclusive of skilled care, custodial care or any other level of nursing home care including but not limited to emergency placement, hospice and respite care. The Contractor will provide an array of Disease Management Programs and Self-Help Medical Management Programs. The Contractor will provide comprehensive treatment for gender dysphoria for all into the list of services included in the comprehensive benefit package.