Common use of Care Coordination Program Clause in Contracts

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. 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 HCAHSD’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 HSD 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 Assignmentassignment; 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) Models of Care Coordination; Transitions of care; Care Coordination systems and analytics; and Care Coordination monitoring and reporting. Care Coordination Staffing and Training Care Coordination Staffing The CONTRACTOR may use a Care Coordination team approach to performing Care Coordination activities described in Section 4.4 of this Agreement. For Members in Care Coordination Levels (CCLs) two (2) and three (3), the CONTRACTOR’s Care Coordination team shall consist of the Member’s care coordinator and other Care Coordination staff with relevant expertise and experience necessary to address the needs of the Members. The CONTRACTOR shall use local resources, such as I/T/Us, primary care and specialty clinics, Patient Centered Medical Homes (PCMHs), Health Homes, Core Service Agencies (CSAs), School-Based Health Center (SBHCs), CHWs, Community Health Representatives (CHRs), High Fidelity Wrap-Around (HFW) Teams, Paramedicine programs, community-based agencies, PCS agencies, Centers for Independent Living, and Tribal services, reimbursing them in mutually agreeable arrangements, to assist in performing the Care Coordination functions specified throughout Section 4.4 of this Agreement. The CONTRACTOR shall perform monitoring and oversight of all Care Coordination functions delegated to local resources, per Section 7.14.2.1.3 of this Agreement. The CONTRACTOR's Care Coordination program description shall specify: The qualifications, experience, and training of each member of the Care Coordination team and how the CONTRACTOR ensures that Care Coordination key functions are performed by a qualified care coordinator and supervised by a qualified supervisor. At a minimum, unless otherwise approved by HSD, the CONTRACTOR shall ensure that the care coordinator completing the CNA has a bachelor's degree or two (2) years of relevant health care experience; and a care coordinator's direct supervisor has a bachelor's degree and a minimum of two (2) years of relevant health care experience, unless approved in writing by HSD; The number of care coordinators, Care Coordination supervisors, and other Care Coordination team members dedicated to the CONTRACTOR’s Care Coordination program; The proposed ratio of care coordinators, subject to HSD-established maximum caseload ratios, to Members and the analysis that supports the proposed ratios are sufficient to meet the needs of the CONTRACTOR’s Members. The CONTRACTOR’s proposed ratios shall consider travel requirements for care coordinators serving Members in Rural, Frontier, and Tribal areas of the State and Members who require more extensive Care Coordination support; The method by which the CONTRACTOR will maintain the ratios approved by HSD; The method by which the CONTRACTOR will ensure that such ratios continue to be sufficient to fulfill the requirements specified in this Agreement; The roles and responsibilities for each member of the Care Coordination team; How the CONTRACTOR will use and expand the use of delegated and local resources to meet the Care Coordination needs of its Members; and How the CONTRACTOR will provide oversight of all Care Coordination functions delegated to local resources. Care Coordinator Training The CONTRACTOR's Care Coordination program description shall specify the onboarding and ongoing training provided to Care Coordination staff by topic, frequency, and modality. Training must include, but is not limited to, the staff training described in Section 3.3.6 of this Agreement. The CONTRACTOR shall use training instructors from New Mexico Tribes. Training shall address all topic areas necessary for Care Coordination staff to perform their job responsibilities in Section 4.4 of this Agreement.