Care Coordination Program. 4.4.2.1 The CONTRACTOR shall design and implement a Care Coordination program that meets the requirements in Section 4.4 of this Agreement.
4.4.2.2 The CONTRACTOR’s Care Coordination program shall be consistent and comply with the requirements in the Managed Care Policy Manual and MCO Systems Manual.
4.4.2.3 The CONTRACTOR shall submit a written Care Coordination program description for HCA’s prior written approval. After the initial submission, the CONTRACTOR shall annually submit a data driven, written evaluation of its Care Coordination program, addressing Member outcomes, identifying areas for improvement, actions taken in response, and any proposed changes to the Care Coordination program for HCA review and prior written approval.
4.4.2.4 The CONTRACTOR’s Care Coordination program description must address each of the following program components, and meet the Care Coordination requirements set forth in this Section 4.4 of this Agreement:
4.4.2.4.1 Care Coordination staffing and training;
4.4.2.4.2 Assessments;
4.4.2.4.3 Care Coordination Level Assignment;
4.4.2.4.4 Comprehensive Care Plan;
4.4.2.4.5 Care Coordination activities;
4.4.2.4.6 Disease Management approach;
4.4.2.4.7 Care Coordination for special and high needs populations;
4.4.2.4.8 Delegated Care Coordination Models (Full Delegation Model or Shared Functions Model, when offered), including the CONTRACTOR’s strategies to promote, support, and expand the availability and use of the Full Delegation Model and the Shared Functions Model (when offered) of Care Coordination;
4.4.2.4.9 Transitions of care;
4.4.2.4.10 Care Coordination systems and analytics; and
4.4.2.4.11 Care Coordination monitoring and reporting.
Care Coordination Program. The CONTRACTOR shall design and implement a Care Coordination program that meets the requirements in Section 4.4 of this Agreement. The CONTRACTOR’s Care Coordination program shall be consistent and comply with the requirements in the Managed Care Policy Manual and MCO Systems Manual. The CONTRACTOR shall submit a written Care Coordination program description for HCA’s prior written approval. After the initial submission, the CONTRACTOR shall annually submit a data driven, written evaluation of its Care Coordination program, addressing Member outcomes, identifying areas for improvement, actions taken in response, and any proposed changes to the Care Coordination program for HCA review and prior written approval. The CONTRACTOR’s Care Coordination program description must address each of the following program components, and meet the Care Coordination requirements set forth in this Section 4.4 of this Agreement: Care Coordination staffing and training; Assessments; Care Coordination Level Assignment; Comprehensive Care Plan; Care Coordination activities; Disease Management approach; Care Coordination for special and high needs populations; Delegated Care Coordination Models (Full Delegation Model or Shared Functions Model, when offered), including the CONTRACTOR’s strategies to promote, support, and expand the availability and use of the Full Delegation Model and the Shared Functions Model (when offered) of Care Coordination; Transitions of care; Care Coordination systems and analytics; and Care Coordination monitoring and reporting.
Care Coordination Program. For all eligible members the CONTRACTOR shall provide a Care Coordination Program designed to help non-CHOICES members who may or may not have a chronic disease but have acute health needs or risks that need immediate attention. The goal of the Care coordination program is to assure members get the services they need to prevent or reduce an adverse health outcome. Services provided are short-term and time limited in nature and should not be confused with the CHOICES Care Coordination Program. Services may include assistance in making and keeping needed medical and or behavioral health appointments, hospital discharge instructions, health coaching and referrals related to the members’ immediate needs, PCP reconnection and offering other resources or materials related to wellness, lifestyle, and prevention. Members receiving care coordination may be those members that were identified for, but declined complex case management
Care Coordination Program. For all eligible members the CONTRACTOR shall provide a Care Coordination Program designed to help non-CHOICES members and non-ECF CHOICES members who may or may not have a chronic disease but have acute health needs or risks that need immediate attention. The goal of the Care coordination program is to assure members get the services they need to prevent or reduce an adverse health outcome. Services provided are short-term and time limited in nature and should not be confused with the CHOICES Care Coordination Programor ECF CHOICES Support Coordination. Services may include assistance in making and keeping needed medical and or behavioral health appointments, hospital discharge instructions, health coaching and referrals related to the members’ immediate needs, PCP reconnection and offering other resources or materials related to wellness, lifestyle, and prevention. Members receiving care coordination may be those members that were identified for, but declined complex case management.
61. Section A.2.8.11 through A.2.8.11.6 shall be amended as follows:
