Common use of Behavioral Health Continuity of Care Clause in Contracts

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.

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-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.

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.. EXHIBIT 1 SCOPE OF WORK