Care Coordination Activities. Provider shall, and shall ensure its Practice Providers engage in the care management of Beneficiaries in accordance with the terms of this Agreement, including the activities set forth in Exhibit H. In connection with such care management activities, Provider shall be eligible for care coordination- related payments in accordance with Exhibit H.
Care Coordination Activities. 2.4.2.2.1. The Contractor shall provide Care Coordination, which shall address Members’ need for integration of mental health services, substance use disorder services, and other health services. This includes identifying, providing, or arranging for services and/or coordinating with other agencies to ensure that the Member receives the health care and supportive services that will allow the Member to remain in her/his community.
2.4.2.2.1.1. This requirement is particularly critical for Medicaid members receiving wrap around services under an HCBS waiver as described in Exhibit I entitled “Wrap Around Services.”
2.4.2.2.1.2. Contractor shall ensure that providers (primarily, but not limited to, Community Mental Health Centers) communicate with and coordinate services with the Single Entry Point (SEP) care manager for each Member who participates in the Waiver for Persons with Mental Illness (HCBS-MI) or Waiver for the Elderly, Blind and Disabled (HCBS-EBD). Communication and coordination is also required with Assisted Living Residences (ALRs) or other supported community living arrangements in which HCBS waiver recipients live.
2.4.2.2.1.3. The Contractor shall also coordinate and provide Covered Services in conjunction with other behavioral health care providers, physical health care providers, long term care providers, waiver services providers, pharmacists, county and state agencies, and other provider organizations that may be providing wrap around services described in the attached document entitled “Wrap Around Services.”
2.4.2.2.2. The Contractor shall coordinate with the Member’s medical health providers to facilitate the delivery of health services, as appropriate.
2.4.2.2.2.1. The Contractor shall make reasonable efforts to assist individuals to obtain necessary medical treatment.
2.4.2.2.2.2. If a Member is unable to arrange for supportive services necessary to obtain medical care due to her/his behavioral health disorders, these supportive services shall be arranged for by the Contractor or another person who has an existing relationship with the Member, whenever possible.
2.4.2.2.3. The Contractor shall work closely and collaboratively with the Regional Care Collaborative Organizations (RCCOs) on care coordination activities as the RCCOs will also be providing care coordination activities to the Medicaid population.
Care Coordination Activities. 4.4.7.1 The CONTRACTOR's Care Coordination program description shall specify the CONTRACTOR’s performance of Care Coordination activities. The process shall be consistent with the requirements for Care Coordination activities in this Section 4.4.7.
4.4.7.2 Care coordinators for Members in CCL2 or CCL3 shall provide and/or arrange for the following Care Coordination services:
4.4.7.2.1 Outreaching to Members to engage in Care Coordination;
4.4.7.2.2 Offering and linking Members who would benefit from a Health Home;
4.4.7.2.3 Leading the development, implementation, and ongoing updates to the CCP;
4.4.7.2.4 Offering and linking Members to targeted health education, disease management (DM), and wellness/prevention coaching, as appropriate, offered through the CONTRACTOR or in the community;
4.4.7.2.5 Coordinating Member access to Covered Services as needed (e.g., scheduling appointments, arranging transportation, making referrals);
4.4.7.2.6 Educating the Member about available community resources and services and assisting the Member in accessing those resources and services;
4.4.7.2.7 Facilitating access to supports that assess housing needs and identify appropriate resources to help Members attain and maintain community housing;
4.4.7.2.8 Informing each Member of the Member’s Medicaid eligibility end date, the importance of maintaining eligibility, and that Members will be contacted near the date on which a redetermination is needed to assist them with the process (e.g., collecting appropriate documentation and completing the necessary forms);
4.4.7.2.9 Performing in-person, in-home CNAs as needed, but at least annually for CCL2 Members and semi-annually for CCL3 Members, to determine if the CCP is appropriate and if a higher or lower level of Care Coordination is needed;
4.4.7.2.10 Performing in-person and in-home visits with the Member as required in the Managed Care Policy Manual;
4.4.7.2.11 Communicating and exchanging information with Providers (e.g., PCP, specialists, labs, imaging facilities, HCBS Providers) to coordinate the care of the Member;
4.4.7.2.12 Participating in discharge planning activities with the discharging inpatient facility (including SUD and psychiatric facilities) to support a safe discharge placement and to prevent unplanned or unnecessary readmissions, ED visits, and adverse outcomes;
4.4.7.2.13 Ensuring Member access to post discharge services as specified in the discharge plan;
4.4.7.2.14 Facilitating clinical hand offs betwe...
