Common use of Access to Care and Service Management Clause in Contracts

Access to Care and Service Management. Once identified, the MCO must have effective systems to ensure the provision of Covered Services to meet the special preventive, primary Acute Care, and specialty health care needs appropriate for treatment of a Member’s condition(s). All STAR+PLUS and Former Xxxxxx Care Child (FFCC) Members are considered MSHCN. The MCO must provide access to identified PCPs and specialty care Providers with experience serving MSHCN. Such Providers must be board-qualified or board-eligible in their specialty. The MCO may request exceptions from HHSC for approval of traditional providers who are not board-qualified or board-eligible but who otherwise meet the MCO’s credentialing requirements. The MCO must have Network PCPs and specialty care Providers that have demonstrated experience with children who have special health needs in pediatric specialty centers such as children’s Hospitals, teaching Hospitals, and tertiary care centers. The MCO is responsible for working with MSHCN, their health care providers, their families and, if applicable, legal guardians to develop a seamless package of care in which primary, Acute Care, and specialty service needs are met through a Service Plan that is understandable to the Member, and his or her representatives. The Service Plan includes, but is not limited to, the following:

Access to Care and Service Management. Once identified, the MCO must have effective systems to ensure the provision of Covered Services to meet the special preventive, primary Acute Care, and specialty health care needs appropriate for treatment of a Member’s condition(s). All STAR+PLUS and Former Xxxxxx Care Child (FFCC) Members are considered MSHCN. The MCO must provide access to identified PCPs and specialty care Providers with experience serving MSHCN. Such Providers must be board-qualified or board-eligible in their specialty. The MCO may request exceptions from HHSC for approval of traditional providers who are not board-qualified or board-eligible but who otherwise meet the MCO’s credentialing requirements. The For services to CSHCN, the MCO must have Network PCPs and specialty care Providers that have demonstrated experience with children who have special health needs CSHCN in pediatric specialty centers such as children’s Hospitals, teaching Hospitals, and tertiary care centers. The MCO is responsible for working with MSHCN, their health care providers, their families and, if applicable, legal guardians to develop a seamless package of care in which primary, Acute Care, and specialty service needs are met through a Service Plan that is understandable to the Member, and his or her representatives. The Service Plan includes, but is not limited to, the following: 1. the Member’s history; 2. summary of current medical and social needs and concerns; 3. short and long term needs and goals;

Access to Care and Service Management. Once identified, the MCO must have effective systems to ensure the provision of Covered Services to meet the special preventive, primary Acute Care, and specialty health care needs appropriate for treatment of a Member’s condition(s). All STAR+PLUS and Former Xxxxxx Care Child (FFCC) Members are considered MSHCN. The MCO must provide access to identified PCPs and specialty care Providers with experience serving MSHCN. Such Providers must be board-qualified or board-eligible in their specialty. The MCO may request exceptions from HHSC for approval of traditional providers who are not board-qualified or board-eligible but who otherwise meet the MCO’s credentialing requirements. The MCO must have Network PCPs and specialty care Providers that have demonstrated experience with children who have special health needs in pediatric specialty centers such as children’s Hospitals, teaching Hospitals, and tertiary care centers. The MCO is responsible for working with MSHCN, their health care providers, their families and, if applicable, legal guardians to develop a seamless package of care in which primary, Acute Care, and specialty service needs are met through a Service Plan that is understandable to the Member, and his or her representatives. The Service Plan includes, but is not limited to, the following: 1. the Member’s history; 2. summary of current medical and social needs and concerns; 3. short and long term needs and goals;