Behavioral Health Continuity of Care Sample Clauses

Behavioral Health Continuity of Care. The Contractor shall utilize behavioral health case managers to monitor the care of members receiving behavioral health services who are new to the Contractor or who are transitioning to another MCE or other treatment provider, to ensure that medical records, treatment plans and other pertinent medical information follows each transitioning member. The Contractor shall notify the receiving MCE or other provider of the member’s previous behavioral health treatment, and shall offer to provide to the new provider the member’s treatment plan, if available, and consultation with the member’s previous treating provider. The Contractor and receiving MCE shall coordinate information regarding prior authorized services for members in transition. The Contractor shall require, through provider contract provisions, that members receiving inpatient psychiatric services are scheduled for outpatient follow-up and/or continuing treatment prior to discharge. This treatment shall be provided within seven (7) calendar days from the date of the member’s discharge. If a member misses an outpatient follow-up or continuing treatment, the Contractor shall ensure that a behavioral health care provider or the Contractor’s behavioral health case manager contacts that member within three (3) business days of notification of the missed appointment.
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Behavioral Health Continuity of Care. The Contractor must monitor the care of a member receiving behavioral health services who is new to the Contractor or who is transitioning to another managed care entity (MCE) or other treatment provider, to ensure that medical records, treatment plans and other pertinent medical information follows the transitioning member. The Contractor must notify the receiving MCE or other provider of the member’s previous behavioral health treatment, and must offer to provide to the new provider the member’s treatment plan, if available, and consultation with the member’s previous treating provider. The Contractor and receiving MCE must coordinate information regarding prior authorized services for members in transition in accordance with Section 3.15. The Contractor must ensure there is adequate discharge planning for members hospitalized for a behavioral health condition. Members must not be discharged to homelessness. The Contractor shall coordinate with hospital discharge planners and CMHC case managers (if the member is receiving case management through a CMHC). The Contractor must require, through provider agreement provisions, that members receiving inpatient psychiatric services are scheduled for outpatient follow-up and/or continuing treatment prior to discharge. The Contractor shall make every effort to ensure treatment is provided within seven (7) calendar days from the date of the member’s discharge. If a member misses an outpatient follow-up or continuing treatment, the Contractor must ensure that a behavioral health care provider or the Contractor’s behavioral health case manager contacts that member within three (3) business days of the missed appointment. The State is exploring implementation of new initiatives for behavioral health integration for Indiana Medicaid members that is expected to result in a higher level of integration of services. The Contractor shall provide enhanced care coordination at the direction of the State as a result of these initiatives.
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Behavioral Health Continuity of Care. The Contractor shall utilize behavioral health case managers to monitor the care of members receiving behavioral health services who are new to the Contractor or who are transitioning to another MCE or other treatment provider, to ensure that medical records, treatment plans and other pertinent medical information follows each transitioning member. The Contractor shall notify the receiving MCE or other provider of the member’s previous behavioral health treatment, and shall offer to provide to the new provider the member’s treatment plan, if available, and consultation with the member’s previous treating provider. The Contractor and receiving MCE shall coordinate information regarding prior authorized services for members in transition. The Contractor shall require, through provider contract provisions, that members receiving inpatient psychiatric services are scheduled for outpatient follow-up and/or continuing treatment prior to discharge. This treatment shall be provided within seven
Sample 1Sample 2Sample 3See All (8)
Behavioral Health Continuity of Care. The Contractor must monitor the care of a member receiving behavioral health services who is new to the Contractor or who is transitioning to another managed care entity (MCE) or other treatment provider, to ensure that medical records, treatment plans and other pertinent medical information follows the transitioning member. The Contractor must notify the receiving MCE or other provider of the member’s previous behavioral health treatment, and must offer to provide to the new provider the member’s treatment plan, if available, and consultation with the member’s previous treating provider. The Contractor and receiving MCE must coordinate information regarding prior authorized services for members in transition in accordance with Section 3.15. The Contractor must ensure there is adequate discharge planning for members hospitalized for a behavioral health condition. Respondents shall explain how they will coordinate with hospital discharge planners and CMHC case managers (if the member is receiving case management through a CMHC). T he Contractor must require, through provider agreement provisions, that members receiving inpatient psychiatric services are scheduled for outpatient follow-up and/or continuing treatment prior to discharge. This treatment must be provided within seven (7) calendar days from the date of the member’s discharge. If a member misses an outpatient follow-up or continuing treatment, the Contractor must ensure that a behavioral health care provider or the Contractor’s behavioral health case manager contacts that member within three (3) business days of the missed appointment.
Sample 1Sample 2Sample 3See All (7)
Behavioral Health Continuity of Care. The Contractor must monitor the care of a member receiving behavioral health services who is new to the Contractor or who is transitioning to another managed care entity (MCE) or other treatment provider, to ensure that medical records, treatment plans and other pertinent medical information follows the transitioning member. The Contractor must notify the receiving MCE or other provider of the member’s previous behavioral health treatment, and must offer to provide to the new provider the member’s treatment plan, if available, and consultation with the member’s previous treating provider. The Contractor and receiving MCE must coordinate information regarding prior authorized services for members in transition in accordance with Section 3.15.
Sample 1
Behavioral Health Continuity of Care. The Contractor shall utilize behavioral health case managers to monitor the care of members receiving behavioral health services who are new to the Contractor or who are transitioning to another MCE or other treatment provider, to ensure that medical records, treatment plans and other pertinent medical information follows each transitioning member. The Contractor shall notify the receiving MCE or other provider of the previous treating provider. The Contractor and receiving MCE shall coordinate information regarding prior authorized services for members in transition. The Contractor shall require, through provider contract provisions, that members receiving inpatient psychiatric services are scheduled for outpatient follow-up and/or continuing treatment prior to discharge. This treatment shall be provided within seven (7) calendar d outpatient follow-up or continuing treatment, the Contractor shall ensure that a behavioral member within three (3) business days of notification of the missed appointment.
Sample 1

Related to Behavioral Health Continuity of Care

  • Behavioral Health Services Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

  • Clinical Management for Behavioral Health Services (CMBHS) System 1. request access to CMBHS via the CMBHS Helpline at (000) 000-0000. 2. use the CMBHS time frames specified by System Agency. 3. use System Agency-specified functionality of the CMBHS in its entirety. 4. submit all bills and reports to System Agency through the CMBHS, unless otherwise instructed.

  • Continuity of Care OMPP is committed to providing continuity of care for members as they transition between various IHCP programs and the Contractor’s enrollment. The Contractor shall have mechanisms in place to ensure the continuity of care and coordination of medically necessary health care services for its Hoosier Healthwise members. The State emphasizes several critically important areas where the Contractor shall address continuity of care. Critical continuity of care areas include, but are not limited to:  Transitions for members receiving HIV, Hepatitis C and/or behavioral health services, especially for those members who have received prior authorization from their previous MCE or through fee-for-service;  Transitions for members who are pregnant;  A member’s transition into the Hoosier Healthwise program from traditional fee- for-service or HIP;  A member’s transition between MCEs, particularly during an inpatient stay;  A member’s transition between IHCP programs, Members exiting the Hoosier Healthwise program to receive excluded services;  A member’s exiting the Hoosier Healthwise program to receive excluded services;  A member’s transition to a new PMP;  A member’s transition to private insurance or Marketplace coverage; and  A member’s transition to no coverage. In situations such as a member or PMP disenrollment, the Contractor shall facilitate care coordination with other MCEs or other PMPs. When receiving members from another MCE or fee-for-service, the Contractor shall honor the previous care authorizations for a minimum of thirty (30) calendar days from the member’s date of enrollment with the Contractor. Contractor shall establish policies and procedures for identifying outstanding prior authorization decisions at the time of the member’s enrollment in their plan. For purposes of clarification, the date of member enrollment for purposes of the prior authorization time frames set forth in this section begin on the date the Contractor receives the member’s fully eligible file from the State. Additionally, when a member transitions to another source of coverage, the Contractor shall be responsible for providing the receiving entity with information on any current service authorizations, utilization data and other applicable clinical information such as disease management, case management or care management notes. This process shall be overseen by the Transition Coordination Manager. The Contractor will be responsible for care coordination after the member has disenrolled from the Contractor whenever the member disenrollment occurs during an inpatient stay. In these cases, the Contractor will remain financially responsible for the hospital DRG payment and any outlier payments (without a capitation payment) until the member is discharged from the hospital or the member’s eligibility in Medicaid terminates. The Contractor shall coordinate discharge plans with the member’s new MCE. See Section 3.7.5 for additional requirements regarding continuity of care for behavioral health services. The Hoosier Healthwise MCE Policies and Procedures Manual describes the Contractor’s continuity and coordination of care responsibilities in more detail.

  • Health Promotion and Health Education Both parties to this Agreement recognize the value and importance of health promotion and health education programs. Such programs can assist employees and their dependents to maintain and enhance their health, and to make appropriate use of the health care system. To work toward these goals:

  • Pharmacy Services The Contractor shall establish a network of pharmacies. The Contractor or its PBM must provide at least two (2) pharmacy providers within thirty (30) miles or thirty (30) minutes from a member’s residence in each county, as well as at least two (2) durable medical equipment providers in each county or contiguous county.

  • Health Care Operations “Health Care Operations” shall have the same meaning as the term “health care operations” in 45 CFR §164.501.

  • Disaster Services In the event of a local, state, or federal emergency, including natural, man-made, criminal, terrorist, and/or bioterrorism events, declared as a state disaster by the Governor, or a federal disaster declared by the appropriate federal official, Grantee may be called upon to assist the System Agency in providing the following services: i. Community evacuation; ii. Health and medical assistance; iii. Assessment of health and medical needs; iv. Health surveillance; v. Medical care personnel; vi. Health and medical equipment and supplies; vii. Patient evacuation; viii. In-hospital care and hospital facility status; ix. Food, drug and medical device safety; x. Worker health and safety; xi. Mental health and substance abuse; xii. Public health information; xiii. Vector control and veterinary services; and xiv. Victim identification and mortuary services.

  • Extended Health Care Plan ‌ The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable extended health care plan.

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