Care Coordination. The Parties’ subcontract shall require that the Enrollee’s CP Care Coordinator provide ongoing care coordination support to the Enrollee in coordination with the Enrollee’s PCP and other providers as set forth in Section 2.6.
Care Coordination. Care coordination is defined as the organized delivery of member care activities between two (2) or more participants (including the member) involved in a member’s care to facilitate the appropriate delivery of health care services. Organizing care involves the marshaling of personnel and other resources needed to carry out all medically necessary member care activities and is often managed by the exchange of information among participants responsible for different aspects of care.
Care Coordination. MCOs must ensure care coordination is provided to Members with a substance use disorder. MCOs must work with providers, facilities, and Members to coordinate care for Members with a substance use disorder and to ensure Members have access to the full continuum of Covered Services (including without limitation assessment, detoxification, residential treatment, outpatient services, and medication therapy) as Medically Necessary and appropriate. MCOs must also coordinate services with the DSHS, DFPS, and their designees for Members requiring Non-Capitated Services. Non-Capitated Services includes, without limitation, services that are not available for coverage under the Contract, State Plan or Waiver that are available under the Federal Substance Abuse and Prevention and Treatment block grant when provided by a DSHS-funded provider or covered by the DFPS under direct contract with a treatment provider. MCOs must work with DSHS, DFPS, and providers to ensure payment for Covered Services is available to Out-of-Network Providers who also provide related Non-capitated Services when the Covered Services are not available through Network Providers.
Care Coordination. Prior to Contract start date and on an annual basis, the Contractor shall submit for approval to the State a Care Coordination Operational Plan. The Contractor must receive approval before member stratification. The operational plan shall include, but not limited to, the following: care coordination team member roles, care coordination team organizational chart, team member training requirements, team member educational and/or experience requirements, screening tool, stratification methodology (including, caseload ratios per stratification level), reassessment frequency, and care plan components. The Contractor’s care coordination operational plan and service delivery must contain evidence of person-centered practices in all aspects. In addition, the care coordination plan may be modified if the Contractor receives written approval from FSSA. The Contractor shall implement a transition of care policy that is consistent with federal requirements and at least meets the State defined transition of care policies in the HIP MCE Policies and Procedures Manual per 42 CFR 438.62(b)(1)-(2). In accordance with 42 CFR 438.208(b)(2)(i)-(iv) and 42 CFR 438.208(b)(4), the Contractor shall implement procedures to coordinate: ▪ Services the Contractor furnishes to the member between settings of care, including appropriate discharge planning for short-term and long-term hospital and institutional stays; ▪ Services the Contractor furnishes to the member with the services the member receives from any other MCE or health plan; ▪ Services the Contractor furnishes to the member with the services the member receives in FFS Medicaid; ▪ Services the Contractor furnishes to the member with the services the member receives from community and social support providers; and ▪ Sharing results of any identification of member needs from assessments with the State or other health plans.
Care Coordination. The Contractor shall offer care coordination and case management services to all Enrollees, as described in Welfare and Institutions Code sections 14182.17(d)(4) and 14186(b).
2.5.2.1. Contractor will coordinate Enrollee care across the full continuum of service providers, including medical, Behavioral Health, and LTSS.
2.5.2.2. Contractor will focus on providing services in the least restrictive setting.
2.5.2.3. Care coordination will be led by the Care Coordinator with participation by members of the ICT.
2.5.2.4. Contractor shall ensure effective linkages of clinical and management systems among Network Providers. Such linkages shall be established in plan policies and procedures.
2.5.2.4.1. Such linkages shall include communication protocols among First Tier, Downstream, and Related Entities.
2.5.2.5. Contractor’s policies and procedures shall clarify all communications and reporting protocols related to coordination of services including but not limited to how Contractor shall oversee all such coordination activities.
2.5.2.6. Contractor will ensure that care coordination services:
2.5.2.6.1. Reflect a person-centered, outcome-based approach, consistent with the, CFAM-MOU, and DHCS’ RFS;Follow Enrollee’s direction about the level of involvement of his or her caregivers or medical providers;
2.5.2.6.2. Span medical and LTSS systems, including coordination with IHSS, with a focus on transitions;
2.5.2.6.3. Reflect coordination with county agencies and direct contractors, if applicable, for Behavioral Health services;
2.5.2.6.4. Reflect coordination with county agencies, if applicable, for IHSS services;
2.5.2.6.5. Include development of Individual Care Plans (ICP) with Enrollees, as described in Section 2.8.3;
2.5.2.6.6. Are performed by nurses, social workers, primary care providers, if appropriate, other medical, Behavioral Health, or LTSS professionals, and health plan care coordinators, as applicable; and
2.5.2.6.7. Reflect access to appropriate community resources, as defined in Welfare and Institution Code sections 14132.275(f)(7) and 14182.17(d) (4)(G) and (6)(B) and monitoring of skilled nursing utilization, with a focus on providing services in the least restrictive setting and transitions between the facilities and community.
2.5.2.7. Contractor will have a process for assigning a Care Coordinator to each Enrollee. Assignment will be made to a Care Coordinator with the appropriate experience and qualifications based on an Enrollee’s assigned ...
Care Coordination. Contractor shall coordinate and work collaboratively with MSSP providers on care coordination activities surrounding the MSSP Waiver Participant including, but not limited to: coordination of benefits between Contractor and MSSP provider to avoid duplication of services and coordinate Care Management activities particularly at the point of discharge from the MSSP.
Care Coordination. Required expectations for care coordination in the context of a care management plan shall include, but not be limited to:
a) Outreach and contacts/communication to support patient engagement,
b) Conducting screening, record review and documentation as part of Evaluation and Assessment,
c) Tracking and facilitating follow up on referrals and post discharge,
d) Care Planning,
e) Managing transitions of care activities to support continuity of care, to include arranging for timely referral appointments and coordinating and transferring necessary information with appropriate consent(s) between internal and external providers.
f) Address social supports and making linkages to services addressing housing, food, etc., and g) Monitoring, Reporting and Documentation.
Care Coordination i. The Parties must adopt policies and procedures for coordinating Members’ access to care and services that incorporate all the specific requirements set forth in this MOU and for MHP’s to ensure Medically Necessary NSMHS and SMHS provided concurrently are coordinated and non-duplicative.
ii. The Parties must discuss and address individual care coordination issues or barriers to care coordination efforts at least quarterly.
iii. The Parties must establish policies and procedures to maintain collaboration with MHP/DMC-ODS each other and to identify strategies to monitor and assess the effectiveness of this MOU. The MHP policies and procedures must ensure coordination of inpatient and outpatient medical and mental health care for all Members enrolled in MCP and receiving SMHS through MHP, and must comply with federal and State law, regulations, and guidance, including Cal. Welf. & Inst. Code Section 5328.
iv. The Parties must establish and implement policies and procedures that align for coordinating Members’ care that address:
1. The requirement for DMC-ODS to refer Members to MCP to be assessed for care coordination and other similar programs and other services for which they may qualify provided by MCP including, but not limited to, ECM, CCM, or Community Supports;
2. The specific point of contact from each Party, if someone other than each Party’s Responsible Person, to act as the liaison between Parties and be responsible for initiating, providing, and maintaining ongoing care coordination for all Members under this MOU.
3. A process for coordinating care for MHP individuals who meet access criteria for and are concurrently receiving NSMHS and SMHS consistent with the No Wrong Door for Mental Health Services Policy described in APL 22-005 and BHIN 22- 011 to ensure the care is clinically appropriate and non-duplicative and considers the Member’s established therapeutic relationships; Also, a process for how MCP and DMC- ODS will engage in collaborative treatment planning to ensure care is clinically appropriate and non-duplicative and considers the Member’s established therapeutic relationships;
4. A process for coordinating the delivery of medically necessary Covered Services with the Member’s Primary Care Provider, including without limitation transportation services, home health services, and other Medically Necessary Covered Services for eligible members.
5. For MHP only, permitting Members to concurrently receive NSMHS and SMHS when clinically app...
Care Coordination. A process used by a person or team to assist Enrollees in accessing Medicare and Medicaid services, as well as social, educational, and other support services, regardless of the funding source for the services. It is characterized by advocacy, communication, and resource management to promote quality, cost effectiveness and positive outcomes.
Care Coordination. The Contractor shall implement a transition of care policy that is consistent with federal requirements and at least meets the State defined transition of care policy in the Hoosier Care Connect Policy and Procedure Manual pursuant to 42 CFR 438.62(b)(1)-(2). In accordance with 42 CFR 438.208(b)(2)(i)-(iv) and 42 CFR 438.208(b)(4), the Contractor shall implement procedures to coordinate: ▪ Services the Contractor furnishes to the member between settings of care, including appropriate discharge planning for short-term and long-term hospital and institutional stays; ▪ Services the Contractor furnishes to the member with the services the member receives from any other MCE or health plan; ▪ Services the Contractor furnishes to the member with the services the member receives in FFS Medicaid; ▪ Services the Contractor furnishes to the member with the services the member receives from community and social support providers; ▪ Sharing results of any identification of member needs from assessments with the State or other health plans.
