Common use of Behavioral Health Network Requirements Clause in Contracts

Behavioral Health Network Requirements. Substance Use Disorder Treatment Providers To the extent permitted by law, the Contractor shall require all substance use disorder treatment providers to submit to DPH/BSAS the data required by DPH. The Contractor shall require all substance use disorder treatment providers to track, by referral source: All referrals for services; The outcome of each referral (i.e., admission, etc.); and If the substance use disorder treatment provider refuses to accept a referral, the reason for the refusal. The Contractor shall, unless otherwise directed by XXXXX, work collaboratively with EOHHS and with MassHealth‑contracted plans to implement a unified Network Management strategy for managing the ASAM Level 3.1 Residential Rehabilitation Services for Substance Use Disorders network, including Enhanced Residential Rehabilitation Services (“the RRS network”). The Contractor shall: As further directed by EOHHS and in accordance with all other applicable Contract requirements, contract with all willing, qualified, and licensed RRS providers; The Contractor shall support each RRS provider’s efforts to establish and sustain collaborative partnerships among service providers and community stakeholders in its geographic area; Ensure that RRS is provided in accordance with EOHHS‑ approved RRS performance specifications and RRS Medical Necessity Criteria which shall align with the American Society For Addiction Medicine (ASAM) criteria; Submit for EOHHS’s approval authorization and concurrent review procedures for RRS, and any changes to such authorization and concurrent review procedures prior to their implementation. The Contractor shall: Utilize the American Society for Addiction Medicine (ASAM) criteria as the basis for establishing authorization and concurrent review procedures; Assist RRS Providers in learning how to utilize the Contractor’s authorization and concurrent review procedures with respect to RRS; Ensure that the authorization procedures established for RRS allow for at least the first ninety (90) days to occur without prior approval, provided however that the Contractor may establish notification or registration procedures during the first ninety (90) days of RRS; and Assign a single point of contact for management of the RRS network. The Contractor’s single point of contact’s responsibilities shall include, but not be limited to, providing in‑ person technical assistance to RRS Providers to answer questions regarding billing and authorization of services and assisting RRS Providers in facilitating and ensuring that Enrollees are connected to other services as indicated by the Enrollees treatment plan; The Contractor shall, unless otherwise directed by XXXXX, work collaboratively with EOHHS and with MassHealth‑contracted plans to implement a unified Network Management strategy for managing Recovery Coach services. The Contractor shall: As directed by EOHHS and in accordance with all other applicable Contract requirements, contract with all licensed behavioral health outpatient and licensed opioid treatment programs that offer Recovery Coach services in the One Care Plan’s Service Area; Ensure that Recovery Coach services are provided in accordance with all EOHHS approved Recovery Coach performance specifications and Recovery Coach Medical Necessity Criteria; and Submit for EOHHS’ approval authorization and concurrent review procedures for Recovery Coach services, and any changes to such authorization and concurrent review procedures prior to their implementation. The Contractor shall: Assist Providers in learning how to utilize the Contractor’s authorization and concurrent review procedures with respect to Recovery Coach services; and Ensure that the authorization procedures established for Recovery Coach services allow for at least the first one hundred and eighty (180) days to occur without prior approval, provided however that the Contractor may establish notification or registration procedures during the first one hundred and eighty (180) days of Recovery Coach services; The Contractor shall, unless otherwise directed by EOHHS, work collaboratively with EOHHS and with MassHealth‑contracted plans to implement a unified Network Management strategy for managing the Recovery Support Navigator network. The Contractor shall: As directed by EOHHS and in accordance with all other applicable Contract requirements, contract with all licensed behavioral health outpatient and licensed opioid treatment programs that offer Recovery Support Navigator services in the One Care Plan’s Service Area; Ensure that Recovery Support Navigator services are provided in accordance with all EOHHS approved Recovery Support Navigator performance specifications and Recovery Support Navigator Medical Necessity Criteria; Submit for EOHHS’s approval authorization and concurrent review procedures for Recovery Support Navigator services, and any changes to such authorization and concurrent review procedures prior to their implementation. The Contractor shall: Assist Providers in learning how to utilize the Contractor’s authorization and concurrent review procedures with respect to Recovery Support Navigator services; and Ensure that the authorization procedures established for Recovery Support Navigator allow for at least the first ninety (90) days to occur without prior approval, provided however that the Contractor may establish notification or registration procedures during the first ninety (90) days of Recovery Support Navigator services. State‑Operated Community Mental Health Centers (SOCMHCs) The Contractor shall refer cases to the SOCMHCs in a manner that is consistent with the policies and procedures for network referrals generally. Emergency Services Programs (ESPs) The Contractor must maintain relationships execute and maintain contracts with the Emergency Services Program (ESP) providers that are located within the Contractor’s Service Area to provide ESP services. The Contractor must execute and maintain contracts with ESPs that are not run by the Department of Mental Health. If the Contractor does not contract with ESPs operated by DMH, the Contractor shall coordinate admissions and triage with DMH ESPs as it would with any contracted ESP. The Contractor must include the ESPs serving members in each county where the Contractor operates in its Behavioral Health Provider Network as part of the Covered Services for Behavioral health as referenced in Appendix A and defined in Appendix B. The Contractor will contract with the ESPs according to the established Performance Specifications that currently exist for MassHealth‑only members. The Contractor must contract with hospitals operated by the DMH and the DPH.

Behavioral Health Network Requirements. Substance Use Disorder Treatment Providers To the extent permitted by law, the Contractor shall require all substance use disorder treatment providers to submit to DPH/BSAS the data required by DPH. The Contractor shall require all substance use disorder treatment providers to track, by referral source: All referrals for services; The outcome of each referral (i.e., admission, etc.); and If the substance use disorder treatment provider refuses to accept a referral, the reason for the refusal. The Contractor shall, unless otherwise directed by XXXXX, work collaboratively with EOHHS and with MassHealth‑contracted plans to shall implement a unified Network Management strategy that ensures access to the continuum of care for managing Behavioral Health, consistent with the ASAM Level 3.1 Residential Rehabilitation Services for Substance Use Disorders network, including Enhanced Residential Rehabilitation Services (“the RRS network”)Behavioral Health requirements in Section 2.7 and 2.8. The Contractor shall: As further directed by EOHHS and in accordance with all other applicable Contract requirements, contract with all willing, qualified, and licensed RRS providers; The Contractor shall support each RRS provider’s efforts to establish and sustain collaborative partnerships among service providers and community stakeholders in its geographic area; Ensure that RRS is provided in accordance with EOHHS‑ approved RRS performance specifications and RRS Medical Necessity Criteria which shall align with the American Society For Addiction Medicine (ASAM) criteria; Submit for EOHHS’s approval authorization and concurrent review procedures for RRS, and any changes to such authorization and concurrent review procedures prior to their implementation. The Contractor shall: Utilize the American Society for Addiction Medicine (ASAM) criteria as the basis for establishing authorization and concurrent review procedures; Assist RRS Providers in learning how to utilize the Contractor’s authorization and concurrent review procedures with respect to RRS; Ensure that the authorization procedures established for RRS allow for at least the first ninety (90) days to occur without prior approval, provided however that the Contractor may establish notification or registration procedures during the first ninety (90) days of RRS; and Assign a single point of contact for management of the RRS network. The Contractor’s single point of contact’s responsibilities network shall include, but not be limited at a minimum, access to, providing in‑ person technical assistance to RRS Providers to answer questions regarding billing and authorization of services and assisting RRS Providers : All Behavioral Health Services listed in facilitating and ensuring that Enrollees are connected to other services as indicated by the Enrollees treatment planAppendix C; The Contractor shall, unless otherwise directed by XXXXX, work collaboratively with EOHHS and with MassHealth‑contracted plans to implement a unified Network Management strategy for managing Recovery Coach services. The Contractor shall: As directed by EOHHS and MassHealth Community Behavioral Health Centers (CBHCs) listed in accordance with all other applicable Contract requirements, contract with all licensed behavioral health outpatient and licensed opioid treatment programs that offer Recovery Coach services in the One Care Plan’s Service AreaAppendix G Exhibit 1; Ensure that Recovery Coach services are provided in accordance with all EOHHS approved Recovery Coach performance specifications and Recovery Coach Medical Necessity Criteria; and Submit for EOHHS’ approval authorization and concurrent review procedures for Recovery Coach services, and any changes to such authorization and concurrent review procedures prior to their implementation. The Contractor shall: Assist Providers in learning how to utilize the Contractor’s authorization and concurrent review procedures with respect to Recovery Coach services; and Ensure that the authorization procedures established for Recovery Coach services allow for at least the first one hundred and eighty (180) days to occur without prior approval, provided however that the Contractor may establish notification or registration procedures during the first one hundred and eighty (180) days of Recovery Coach services; The Contractor shall, unless otherwise directed by EOHHS, work collaboratively with EOHHS and with MassHealth‑contracted plans to implement a unified Network Management strategy for managing the Recovery Support Navigator network. The Contractor shall: As directed by EOHHS and in accordance with all other applicable Contract requirements, contract with all licensed behavioral health outpatient and licensed opioid treatment programs that offer Recovery Support Navigator services in the One Care Plan’s Service Area; Ensure that Recovery Support Navigator services are provided in accordance with all EOHHS approved Recovery Support Navigator performance specifications and Recovery Support Navigator Medical Necessity Criteria; Submit for EOHHS’s approval authorization and concurrent review procedures for Recovery Support Navigator services, and any changes to such authorization and concurrent review procedures prior to their implementation. The Contractor shall: Assist Providers in learning how to utilize the Contractor’s authorization and concurrent review procedures with respect to Recovery Support Navigator services; and Ensure that the authorization procedures established for Recovery Support Navigator allow for at least the first ninety (90) days to occur without prior approval, provided however that the Contractor may establish notification or registration procedures during the first ninety (90) days of Recovery Support Navigator services. State‑Operated State-Operated Community Mental Health Centers (SOCMHCs) listed in Appendix G Exhibit 2, Hospitals Operated by DMH in Appendix G Exhibit 4; and Covered Services in Appendix C, Exhibit 2. The Contractor shall refer cases to the SOCMHCs in a manner that is consistent with the policies and procedures for network Network referrals generally. Emergency Services Programs (ESPs) The Contractor must maintain relationships execute and maintain contracts with the Emergency Services Program (ESP) providers that are located within the Contractor’s Service Area See Appendix G, for a list of SOCMHCs, which may be updated by EOHHS from time to provide ESP servicestime. The Contractor must execute and maintain contracts shall require Hospitals with ESPs that are not run by DMH-licensed beds in its Provider Network to comply with the Department of Mental HealthHealth Inpatient Licensing Division Clinical Competencies/ Operational Standards that follow, as they appear in DMH Licensing Division Bulletin #19-01 (or any amended or successor bulletin), when delivering Inpatient Mental Health Services in those DMH-licensed beds to specialty populations. If The Contractor shall require all hospitals in its Provider Network, including those that do not have DMH-licensed beds, to have the capability to treat, in accordance with professionally recognized standards of medical care, all individuals admitted to any unit or bed within the hospital who present with co-occurring behavioral conditions, including, but not limited to, individuals with co-occurring Substance Use Disorders (SUD), Autism Spectrum Disorder and Intellectual and Developmental Disabilities (ASD/ID/DD), and/or individuals who present with a high-level of psychiatric acuity, including severe behavior and assault risk. The Contractor shall work collaboratively with EOHHS and EOHHS's BH Vendor to support the CBHC program, as further specified by EOHHS. Community Support Program for Homeless Individuals (CSP-HI) Subject to the Medical Necessity requirements set forth in 130 CMR 450.204 and Section 1, other Contract requirements, and applicable statutory and regulatory requirements, and in at least the minimum amount, duration, and scope described in 130 CMR 461.403, under CSP-HI the Contractor does shall provide CSP services as set forth in Appendix C to eligible Enrollees who meet the following criteria: Homeless Enrollees who meet the definition of Chronic Homelessness in Section 1.31; or Homeless Enrollees who do not meet the Chronic Homelessness definition but who are also high utilizers of MassHealth services as defined by MassHealth. The Contractor shall: Authorize, arrange, coordinate, and provide CSP-HI services as set forth in Appendix C to Enrollees who meet the criteria under this Section 2.9.3.7; Actively communicate with CSP-HI providers regarding the provision of CSP-HI services to Enrollees, including coordinating care to ensure that Enrollees’ needs are met; Require that Network Providers of CSP-HI have demonstrated experience and employed staff as further specified by EOHHS and in 130 CMR 461.000 including Homelessness experience and expertise; Develop Performance Specifications for the delivery of CSP-HI as specified by EOHHS and submit such Performance Specifications to EOHHS as well as any updates to the specifications as they occur; Pay CSP-HI Providers a daily rate. Once the Enrollee has obtained housing, continue to pay CSP-HI Providers the daily rate until such a time as the Contractor determines that CSP-HI is no longer medically necessary; Ensure that rates paid for CSP-HI services are reflective of the current market rate and are sufficient to ensure network adequacy. The Contractor shall ensure providers comply with billing requirements specified by EOHHS, including but not limited to using codes specified by EOHHS; Designate a single point of contact for CSP-HI to provide information to CSP-HI providers and EOHHS as further specified by EOHHS. This single point of contact shall be the same contract designated for CSP-TPP as described in Section 2.9.3.9; and Collect and maintain written documentation that the Enrollees receiving CSP-HI meet the definitions under Section 2.9.3.7.1, and as further specified by EOHHS. Community Support Program for Justice Involvement (CSP-JI) The Contractor shall ensure access to CSP-JI, Subject to the Medical Necessity requirements under 130 CMR 450.204 and in Section 1, other Contract requirements, and applicable statutory and regulatory requirements and in at least the minimum amount, duration, and scope described in 130 CMR 461.403,the Contractor shall provide CSP services as set forth in Appendix C, to individuals with ESPs operated Justice Involvement as described in this Section. The Contractor shall authorize, arrange, coordinate, and provide CSP services as set forth in Appendix C, to Enrollees with Justice Involvement that consist of intensive, and individualized support delivered face-to-face or via telehealth, as further specified by DMHEOHHS, which shall include: Assisting in enhancing daily living skills; Providing service coordination and linkages; Assisting with obtaining benefits, housing, and healthcare; Developing a safety plan; Providing prevention and intervention; and Fostering empowerment and recovery, including linkages to peer support and self-help groups. The Contractor shall, as further directed by XXXXX, with respect to CSP-JI: Actively communicate with CSP-JI providers regarding the provision of CSP-JI services, including coordinating care to ensure that individuals’ needs are met, Ensure that network providers of CSP-JI have demonstrated experience and engage in specialized training, Report to EOHHS about its network providers of CSP-JI in accordance with Appendix A, and Designate a single point of contact for CSP-JI to provide information to CSP-JI providers and EOHHS as further specified by EOHHS. When directed by EOHHS, the Contractor shall coordinate admissions maintain agreements with Behavioral Health Supports for individuals with Justice Involvement providers, as further specified by EOHHS. Community Support Program Tenancy Preservation Program (CSP-TPP) Subject to the Medical Necessity requirements under 130 CMR 450.204 and triage with DMH ESPs in Section 1, other Contract requirements, and applicable statutory and regulatory requirements and in at least the minimum amount, duration, and scope described in 130 CMR 461.403,, the Contractor shall provide CSP-TPP services as it would with set forth in Appendix C to Covered Individuals who are at risk of homelessness. For the purposes of this Section “at risk of homelessness” is defined as a Covered Individual who: Does not have sufficient resources or support networks (e.g., family, friends, faith-based, or other social networks) immediately available to prevent them from moving to an emergency shelter or another place not meant for human habitation; Is facing eviction, e.g., the process of obtaining a court order to remove a tenant and other occupants from a rental property including serving either a Notice to Quit or a request for temporary, preliminary, permanent relief. Eviction may also refer to any contracted ESPinstance in which such relief has been granted. The Contractor must include the ESPs serving members in each county where the Contractor operates in its Behavioral Health Provider Network as part of the Covered Services for Behavioral health as referenced in Appendix A and defined in Appendix B. The Contractor will contract with the ESPs according to the established Performance Specifications that currently exist for MassHealth‑only members. The Contractor must contract with hospitals operated by the DMH and the DPH.shall: