Continuity of Care Activities Sample Clauses

Continuity of Care Activities. The CONTRACTOR’s Case Management Program and Policies must address coordination of services for physical and Behavioral Health Services the Member is receiving from another CONTRACTOR’s Health Plan or Provider. 5.5.1 General Continuity of Care Activity Requirements The CONTRACTOR shall: 5.5.1.1 Ensure Continuity of Care activities are consistent with 42 CFR § 438.208 and should provide processes for effective interactions between Medicaid Managed Care Members, in- network and out-of-network Providers and identification and resolution of problems if those interactions are not effective or do not occur. 5.5.2 Service Need Determination The CONTRACOR shall: 5.5.2.1 Assist the Member in determining the need for services outside the Core Benefits and refer the member to the appropriate Provider. 5.5.3 Service Delivery Coordination The CONTRACTOR shall: 5.5.3.1 Coordinate services between settings of care, including appropriate discharge planning for short term and long-term hospital and institutional stays. 5.5.3.2 Coordinate services the member receives through the delivery of Core Benefits with services reimbursed via Medicaid Fee for Service by the Department. 5.5.3.3 Coordinate services the member receives with community and social support Providers. 5.5.3.4 In the event of termination of a CONTRACTOR’s In Network Provider, the CONTRACTOR will continue to pay the Provider until either the Member has finished the course of treatment or until the Provider releases the Member to another Provider who is within the CONTRACTOR’s Provider network. 5.5.3.5 Coordinate services it furnishes to Medicaid Managed Care Members with services the Members receive from other contracted entities.