Common use of Care Coordination Clause in Contracts

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 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. 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- 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-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. 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- 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-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 EXHIBIT 1 SCOPE OF WORK – HEALTHY INDIANA PLAN 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. 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- 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 MCE Policies and Procedures Manual per 42 CFR 438.62(b)(1)-(2). In accordance with 42 CFR 438.208(b)(2)(i)-(iv438.208(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. 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- 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 MCE Policies and Procedures Manual per 42 CFR 438.62(b)(1)-(2). In accordance with 42 CFR 438.208(b)(2)(i)-(iv438.208(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; EXHIBIT 1 SCOPE OF WORK – HOOSIER HEALTHWISE ▪ 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. 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- 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 MCE Policies and Procedures Manual per 42 CFR 438.62(b)(1)-(2). In accordance with 42 CFR 438.208(b)(2)(i)-(iv438.208(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.. EXHIBIT 1 SCOPE OF WORK – HOOSIER HEALTHWISE