Common use of Continuity of Care for New Enrollees Clause in Contracts

Continuity of Care for New Enrollees. The Contractor shall develop and implement policies and procedures to ensure continuity of care for new Enrollees that are enrolling with the Contractor from a different Accountable Care Partnership Plan, a Primary Care ACO, a MassHealth-contracted MCO, the PCC Plan, or a commercial carrier. Such policies and procedures: 1. Shall be for the purpose of minimizing the disruption of care and ensuring uninterrupted access to Medically Necessary ACO Covered Services; 2. Shall address continuity of care for all such Enrollees and include specific policies and procedures for the following individuals at a minimum: a. Enrollees who, at the time of their Enrollment: 1) Are pregnant; 2) Have significant health care needs or complex medical conditions; 3) Have autism spectrum disorder (ASD) and are currently receiving ABA Services, either through MassHealth, another Accountable Care Partnership Plan, a MassHealth-contracted MCO, or a commercial carrier and have a current prior authorization for ABA Services in place; 4) Are receiving ongoing services such as dialysis, home health, chemotherapy and /or radiation therapy; 5) Are hospitalized; or 6) Are receiving treatment for behavioral health or substance use; and b. Enrollees who have received prior authorization for ACO Covered Services including but not limited to: 1) Scheduled surgeries; 2) Out-of-area specialty services; 3) Durable medical equipment (DME) or prosthetics, orthotics, and supplies (POS); 4) Physical therapy (PT), occupational therapy (OT), or speech therapy (ST); or 5) Nursing home admission; 3. Shall include, at a minimum, provisions for: a. Identifying and communicating with Enrollees who would benefit from continuity of care in accordance with this Section, and those Enrollees’ providers (including but not limited to Network Providers); b. Facilitating continuity of care so that new Enrollees may continue to see their current providers (including but not limited to Network Providers) for Medically Necessary ACO Covered Services for at least 30 days after the Effective Date of Enrollment, including but not limited to: 1) Ensuring that Enrollees currently receiving inpatient care (medical or Behavioral Health) from a hospital, including non-Network hospitals, at the time of their Enrollment may continue to receive such care from such hospital as long as such care is Medically Necessary. The Contractor shall make best efforts to contact such hospital to ensure such continuity of care; 2) Ensuring that, for at least 30 days after the Effective Date of Enrollment, new Enrollees receiving outpatient medical, Behavioral Health, or substance use disorder care, including but not limited to Enrollees with upcoming appointments, ongoing treatments or services, or prior authorizations, may continue to seek and receive such care from providers (including non-Network) with whom they have an existing relationship for such care; 3) Ensuring that, for at least 30 days after the Effective Date of Enrollment, new Enrollees with any of the following may have continued access. The Contractor shall ensure such continuity by providing new authorization or extending existing authorization, if necessary, without regard to Medical Necessity criteria, for at least the required 30-day period: a) Durable medical equipment (DME) that was previously authorized by MassHealth, a MassHealth-contracted MCO, or a MassHealth Accountable Care Partnership Plan, or a commercial carrier; b) Prosthetics, orthotics, and supplies (POS) that was previously authorized by MassHealth, a MassHealth-contracted MCO, or a MassHealth Accountable Care Partnership Plan, or a commercial carrier; and c) Physical therapy (PT), occupational therapy (OT), or speech therapy (ST) that was previously authorized by MassHealth, a MassHealth-contracted MCO, or a MassHealth Accountable Care Partnership Plan, or a commercial carrier. 4) Otherwise making accommodations for: a) Upcoming appointments; b) Ongoing treatments or services; c) Pre-existing prescriptions; d) Scheduled and unscheduled inpatient care (medical and Behavioral Health); and e) Other medically necessary services. c. Ensuring that all such providers are able to confirm or obtain any authorization, if needed, for any such services from the Contractor; d. Honoring all prior authorizations and prior approvals for services for the duration of such prior authorizations and prior approvals or, if the Contractor chooses to modify or terminate a prior authorization and prior approval, then the Contractor must treat such modification or termination as an Adverse Action and follow the appeal rights policy and procedures, including notification to the Enrollee and the Enrollee’s provider in question; e. Ensuring appropriate medical record documentation or any continuity of care or transition plan activities as described in this Section; f. Ensuring that all Enrollees, including new Enrollees, may access Emergency Services at any emergency room, including from out-of-Network Providers, and that such Services are provided at no cost to the Enrollee, as described in Section 2.9; g. For Enrollees who have an existing prescription, providing any prescribed refills of such prescription, unless Contractor has a prior authorization policy as described in Section 2.6.B.1.c.2 and such policy requires a prior authorization for such prescription. If Contractor requires such prior authorization, Contractor shall, at a minimum, provide a 72 hour supply of such medication as described in Section 2.6.B.1.c.2; h. For pregnant Enrollees, the following: 1) If a pregnant Enrollee enrolls with the Contractor during a transition period after the Contract Effective Date, to be specified by EOHHS, such Enrollee may choose to remain with her current provider of obstetrical and gynecological services, even if such provider is not in the Contractor’s Provider Network; 2) The Contractor is required to cover all Medically Necessary obstetrical and gynecological services through delivery of the child, as well as immediate post-partum care and the follow-up appointments within the first six weeks of delivery, even if the provider of such services is not in the Contractor’s Provider Network; and 3) However, if a pregnant Enrollee would like to select a new Provider of obstetrician and gynecological services within the Contractor’s Provider Network, such Enrollee may do so; i. For Enrollees affiliated with other state agencies, coordination and consultation with such agencies as described in Sections 2.5.C and 2.6.F; j. For any Enrollee who is identified by EOHHS or by the Contractor as an Enrollee with Special Health Care Needs, completing a Transition Plan no later than 10 business days from the date the Contractor becomes aware of the Enrollee’s health status or condition, but in no case later than 45 days from the Effective Date of Enrollment. Such Transition Plan shall be specific to each such Enrollee’s needs, and shall include processes that address, at a minimum: 1) Medical record documentation; 2) Completion of a Care Needs Screening; 3) Evaluation for Care Management; 4) Coordination and consultation with the Enrollee’s existing Providers; 5) Review of all existing prior authorizations and prescriptions; and 6) Historical utilization data. k. Accepting and utilizing medical records, claims histories, and prior authorizations from an Enrollee’s previous Accountable Care Partnership Plan or MassHealth-contracted MCO. Provisions shall also include accepting and utilizing available medical records, claims histories, and prior authorizations from an Enrollee’s previous commercial carrier, to the extent such information is made available by the Enrollee, the Enrollee’s provider, or MassHealth. The process shall require the Contractor to, at a minimum: 1) Ensure that there is no interruption of ACO Covered Services for Enrollees; 2) Accept the transfer of all medical records and care management data, as directed by EOHHS; 3) Accept the transfer of all administrative documentation, as directed by EOHHS, including but not limited to: a) Provider Fraud investigations; b) Complaints from Enrollees; c) Grievances from Providers and Enrollees; d) Quality Management Plan; and e) Quality Improvement project records; l. Maintaining adequate staffing to fulfill all Contractual obligations throughout the duration of the Contract; m. As directed by EOHHS, participating in any other activities determined necessary by EOHHS to ensure the continuity of care for Enrollees, including making best efforts to: 1) Outreach to New Enrollees within two business days of such New Enrollee’s Effective Date of Enrollment for a period at the start of the Contract to be specified by EOHHS and expected to last no more than 120 days from the Contract Operational Start Date. Such outreach may include telephone calls, mail, or email, as appropriate and compliant with all applicable laws; 2) Obtain any necessary consents from Members who were formerly Enrollees or Enrollees leaving the Contractor’s Plan, in order to transfer certain information specified by EOHHS to such Member’s or Enrollee’s new MassHealth Accountable Care Partnership Plan or MCO Plan; and 3) As directed by EOHHS, transferring all information related to prior authorizations; n. For Enrollees actively receiving ABA Services for autism spectrum disorder, developing protocols to ensure continuity of these services for a minimum of 90 days after such Enrollee is enrolled with the Contractor. Such protocol shall include the use of single-case agreements, full acceptance and implementation of existing prior authorizations for ABA Services, and individual transition plans. 4. Shall, for new Enrollees enrolled pursuant to Section 2.7.A.1.o: a. Include all requirements in Section 2.2.C.1-4 for a period of 90 days following the Enrollee’s enrollment in the Contractor’s plan; b. For such Enrollees that have not transitioned to the Contractor’s Network Providers at the conclusion of such 90-day continuity of care period, include policies and procedures to ensure best efforts for providing uninterrupted care beyond the 90-day period. Such efforts shall include, but shall not be limited to, honoring authorizations from the Enrollee’s previous plan until the Contractor issues new authorizations for Medically Necessary services; paying out-of- network providers for services until such Enrollees have been transitioned to a Network Provider; and other measures as further specified by EOHHS; c. Include policies and procedures to ensure that the Contractor operates efficient provider credentialing processes to add Enrollees’ providers to the Contractor’s Provider Network, in accordance with all other applicable Contract requirements; and d. Include policies and procedures ensuring that the Contractor collaborates with and supports EOHHS in working with such Enrollees and their providers throughout and after the 90-day continuity of care period. Such collaboration and support shall include, but not be limited to, participating in Enrollee outreach, and identifying specific issues and working with EOHHS to resolve those issues. 5. Shall include designating a specific contact person to respond to EOHHS requests and concerns related to continuity of care. The Contractor shall provide EOHHS with such individual’s name, telephone number, and email address, and shall ensure such individual is available to EOHHS during business hours and at other times specified by EOHHS; and 6. Shall be submitted to EOHHS for approval on a date specified by EOHHS.

Continuity of Care for New Enrollees. The Contractor shall develop and implement policies and procedures to ensure continuity of care for new Enrollees that are enrolling with the Contractor from a different another MassHealth- contracted MCO, an Accountable Care Partnership Plan, a Primary Care ACO, a another MassHealth-contracted MCOACO, or the MassHealth PCC Plan, or a commercial carrier. Such policies and procedures: 1. Shall be for the purpose of minimizing the disruption of care and ensuring uninterrupted access to Medically Necessary ACO Covered Servicesservices; 2. Shall address continuity of care for all such Enrollees and include specific policies and procedures for the following individuals at a minimum: a. Enrollees who, at the time of their Enrollment: 1) Are pregnant; 2) Have significant health care needs or complex medical conditions; 3) Have autism spectrum disorder (ASD) and are currently receiving ABA Services, either through MassHealth, another Accountable Care Partnership Plan, a MassHealth-contracted MCO, or a commercial carrier and have a current prior authorization for ABA Services in place; 4) Are receiving ongoing services such as dialysis, home health, chemotherapy and /or radiation therapy; 5) Are hospitalized; or 6) Are receiving treatment for behavioral health or substance use; and b. Enrollees who have received prior authorization for ACO Covered Services services including but not limited to: 1) Scheduled surgeries; 2) Out-of-area specialty services; 3) Durable medical equipment (DME) or prosthetics, orthotics, and supplies (POS); 4) Physical therapy (PT), occupational therapy (OT), or speech therapy (ST); or 5) Nursing home admission; 3. Shall include, at a minimum, provisions for: a. Identifying and communicating with Enrollees who would benefit from continuity of care in accordance with this Section, and those Enrollees’ providers (including but not limited to Network Providers); b. Facilitating continuity of care so that new Enrollees may continue to see their current providers (including but not limited to Network Providers) for Medically Necessary ACO Covered Services services for at least 30 days after the Effective Date of Enrollment, including but not limited to: 1) Ensuring that Enrollees currently receiving inpatient care (medical or Behavioral Health) from a hospital, including non-Network hospitals, at the time of their Enrollment may continue to receive such care from such hospital as long as such care is Medically Necessary. The Contractor shall make best efforts to contact such hospital to ensure such continuity of care; 2) Ensuring that, for at least 30 days after the Effective Date of Enrollment, new Enrollees receiving outpatient medical, Behavioral Health, or substance use disorder care, including but not limited to Enrollees with upcoming appointments, ongoing treatments or services, or prior authorizations, may continue to seek and receive such care from providers (including non-Network) with whom they have an existing relationship for such care; 3) Ensuring that, for at least 30 days after the Effective Date of Enrollment, new Enrollees with any of the following may have continued access. The Contractor shall ensure such continuity by providing new authorization or extending existing authorization, if necessary, without regard to Medical Necessity criteria, for at least the required 30-30 day period: a) Durable medical equipment (DME) that was previously authorized by MassHealth, a MassHealth-contracted MCO, or a MassHealth Accountable Care Partnership Plan, or a commercial carrier; b) Prosthetics, orthotics, and supplies (POS) that was previously authorized by MassHealth, a MassHealth-contracted MCO, or a MassHealth Accountable Care Partnership Plan, or a commercial carrier; and c) Physical therapy (PT), occupational therapy (OT), or speech therapy (ST) that was previously authorized by MassHealth, a MassHealth-contracted MCO, or a MassHealth Accountable Care Partnership Plan, or a commercial carrier. 4) Otherwise making accommodations for: a) Upcoming appointments; b) Ongoing treatments or services; c) Pre-existing prescriptions; d) Scheduled and unscheduled inpatient care (medical and Behavioral Health); and e) Other medically necessary services. c. Ensuring that all such providers are able to confirm or obtain any authorization, if needed, for any such services from the Contractor; d. Honoring all prior authorizations and prior approvals for services for the duration of such prior authorizations and prior approvals or, if the Contractor chooses to modify or terminate a prior authorization and prior approval, then the Contractor must treat such modification or termination as an Adverse Action and follow the appeal rights policy and procedures, including notification to the Enrollee and the Enrollee’s provider in question; e. Ensuring appropriate medical record documentation or any continuity of care or transition plan activities as described in this Section; f. Ensuring that all Enrollees, including new Enrollees, may access Emergency Services at any emergency room, including from out-of-Network Providers, and that such Services are provided at no cost to the Enrollee, as described in Section 2.9; g. For Enrollees who have an existing prescription, providing any prescribed refills of such prescription, unless Contractor has a prior authorization policy as described in Section 2.6.B.1.c.2 and such policy requires a prior authorization for such prescription. If Contractor requires such prior authorization, Contractor shall, at a minimum, provide a 72 hour supply of such medication as described in Section 2.6.B.1.c.22.6.B.1.c .2; h. For pregnant Enrollees, the following: 1) If a pregnant Enrollee enrolls with the Contractor during a transition period after the Contract Effective Date, to be specified by EOHHS, such Enrollee may choose to remain with her current provider of obstetrical and gynecological services, even if such provider is not in the Contractor’s Provider Network; 2) The Contractor is required to cover all Medically Necessary obstetrical and gynecological services through delivery of the child, as well as immediate post-post- partum care and the follow-up appointments within the first six weeks of delivery, even if the provider of such services is not in the Contractor’s Provider Network; and 3) However, if a pregnant Enrollee would like to select a new Provider of obstetrician and gynecological services within the Contractor’s Provider Network, such Enrollee may do so; i. For Enrollees affiliated with other state agencies, coordination and consultation with such agencies as described in Sections 2.5.C and 2.6.F; j. For any Enrollee who is identified by EOHHS or by the Contractor as an Enrollee with Special Health Care Needs, completing a Transition Plan no later than 10 business days from the date the Contractor becomes aware of the Enrollee’s health status or condition, but in no case later than 45 days from the Effective Date of Enrollment. Such Transition Plan shall be specific to each such Enrollee’s needs, and shall include processes that address, at a minimum: 1) Medical record documentation; 2) Completion of a Care Needs Screening; 3) Evaluation for Care Management; 4) Coordination and consultation with the Enrollee’s existing Providers; 5) Review of all existing prior authorizations and prescriptions; and 6) Historical utilization data. k. Accepting and utilizing medical records, claims histories, and prior authorizations from an Enrollee’s previous MassHealth-contracted MCO or Accountable Care Partnership Plan or MassHealth-contracted MCO. Provisions shall also include accepting and utilizing available medical records, claims histories, and prior authorizations from an Enrollee’s previous commercial carrier, to the extent such information is made available by the Enrollee, the Enrollee’s provider, or MassHealthPlan. The process shall require the Contractor to, at a minimum: 1) Ensure that there is no interruption of ACO MCO Covered Services for Enrollees; 2) Accept the transfer of all medical records and care management data, as directed by EOHHS; 3) Accept the transfer of all administrative documentation, as directed by EOHHS, including but not limited to: a) Provider Fraud investigations; b) Complaints from Enrollees; c) Grievances from Providers and Enrollees; d) Quality Management Plan; and e) Quality Improvement project records; l. Maintaining adequate staffing to fulfill all Contractual obligations throughout the duration of the Contract; m. As directed by EOHHS, participating in any other activities determined necessary by EOHHS to ensure the continuity of care for Enrollees, including making best efforts to: 1) Outreach to New Enrollees within two business days of such New Enrollee’s Effective Date of Enrollment for a period at the start of the Contract to be specified by EOHHS and expected to last no more than 120 days from the Contract Operational Start Date. Such outreach may include telephone calls, mail, or email, as appropriate and compliant with all applicable laws; 2) Obtain any necessary consents from Members who were formerly Enrollees or Enrollees leaving the Contractor’s Plan, in order to transfer certain information specified by EOHHS to such Member’s or Enrollee’s new MassHealth Accountable Care Partnership Plan MCO or MCO PlanACO; and 3) As directed by EOHHS, transferring all information related to prior authorizations; n. For Enrollees actively receiving ABA Services for autism spectrum disorder, developing protocols to ensure continuity of these services for a minimum of 90 days after such Enrollee is enrolled with the Contractor. Such protocol shall include the use of single-case agreements, full acceptance and implementation of existing prior authorizations for ABA Services, and individual transition plans. 4. Shall, for new Enrollees enrolled pursuant to Section 2.7.A.1.o: a. Include all requirements in Section 2.2.C.1-4 for a period of 90 days following the Enrollee’s enrollment in the Contractor’s plan; b. For such Enrollees that have not transitioned to the Contractor’s Network Providers at the conclusion of such 90-day continuity of care period, include policies and procedures to ensure best efforts for providing uninterrupted care beyond the 90-day period. Such efforts shall include, but shall not be limited to, honoring authorizations from the Enrollee’s previous plan until the Contractor issues new authorizations for Medically Necessary services; paying out-of- network providers for services until such Enrollees have been transitioned to a Network Provider; and other measures as further specified by EOHHS; c. Include policies and procedures to ensure that the Contractor operates efficient provider credentialing processes to add Enrollees’ providers to the Contractor’s Provider Network, in accordance with all other applicable Contract requirements; and d. Include policies and procedures ensuring that the Contractor collaborates with and supports EOHHS in working with such Enrollees and their providers throughout and after the 90-day continuity of care period. Such collaboration and support shall include, but not be limited to, participating in Enrollee outreach, and identifying specific issues and working with EOHHS to resolve those issues. 5. Shall include designating a specific contact person to respond to EOHHS requests and concerns related to continuity of care. The Contractor shall provide EOHHS with such individual’s name, telephone number, and email address, and shall ensure such individual is available to EOHHS during business hours and at other times specified by EOHHS; and 65. Shall be submitted to EOHHS for approval on a date specified by EOHHS.

Continuity of Care for New Enrollees. The Contractor shall develop and implement policies and procedures to ensure continuity of care for new Enrollees that are enrolling with the Contractor from a different Accountable Care Partnership Plan, a Primary Care ACO, a MassHealth-contracted MCO, or the MassHealth PCC Plan, or a commercial carrier. Such policies and procedures: 1. Shall be for the purpose of minimizing the disruption of care and ensuring uninterrupted access to Medically Necessary ACO Covered Servicesservices; 2. Shall address continuity of care for all such Enrollees and include specific policies and procedures for the following individuals at a minimum: a. Enrollees who, at the time of their Enrollment: 1) Are pregnant; 2) Have significant health care needs or complex medical conditions; 3) Have autism spectrum disorder (ASD) and are currently receiving ABA Services, either through MassHealth, another Accountable Care Partnership Plan, a MassHealth-contracted MCO, or a commercial carrier and have a current prior authorization for ABA Services in place; 4) Are receiving ongoing services such as dialysis, home health, chemotherapy and /or radiation therapy; 5) Are hospitalized; or 6) Are receiving treatment for behavioral health or substance use; and b. Enrollees who have received prior authorization for ACO Covered Services services including but not limited to: 1) Scheduled surgeries; 2) Out-of-area specialty services; 3) Durable medical equipment (DME) or prosthetics, orthotics, and supplies (POS); 4) Physical therapy (PT), occupational therapy (OT), or speech therapy (ST); or 5) Nursing home admission; 3. Shall include, at a minimum, provisions for: a. Identifying and communicating with Enrollees who would benefit from continuity of care in accordance with this Section, and those Enrollees’ providers (including but not limited to Network Providers); b. Facilitating continuity of care so that new Enrollees may continue to see their current providers (including but not limited to Network Providers) for Medically Necessary ACO Covered Services services for at least 30 days after the Effective Date of Enrollment, including but not limited to: 1) Ensuring that Enrollees currently receiving inpatient care (medical or Behavioral Health) from a hospital, including non-Network hospitals, at the time of their Enrollment may continue to receive such care from such hospital as long as such care is Medically Necessary. The Contractor shall make best efforts to contact such hospital to ensure such continuity of care; 2) Ensuring that, for at least 30 days after the Effective Date of Enrollment, new Enrollees receiving outpatient medical, Behavioral Health, or substance use disorder care, including but not limited to Enrollees with upcoming appointments, ongoing treatments or services, or prior authorizations, may continue to seek and receive such care from providers (including non-non- Network) with whom they have an existing relationship for such care; 3) Ensuring that, for at least 30 days after the Effective Date of Enrollment, new Enrollees with any of the following may have continued access. The Contractor shall ensure such continuity by providing new authorization or extending existing authorization, if necessary, without regard to Medical Necessity criteria, for at least the required 30-day period: a) Durable medical equipment (DME) that was previously authorized by MassHealth, a MassHealth-contracted MCO, or a MassHealth Accountable Care Partnership Plan, or a commercial carrier; b) Prosthetics, orthotics, and supplies (POS) that was previously authorized by MassHealth, a MassHealth-MassHealth- contracted MCO, or a MassHealth Accountable Care Partnership Plan, or a commercial carrier; and c) Physical therapy (PT), occupational therapy (OT), or speech therapy (ST) that was previously authorized by MassHealth, a MassHealth-contracted MCO, or a MassHealth Accountable Care Partnership Plan, or a commercial carrier. 4) Otherwise making accommodations for: a) Upcoming appointments; b) Ongoing treatments or services; c) Pre-existing prescriptions; d) Scheduled and unscheduled inpatient care (medical and Behavioral Health); and e) Other medically necessary services. c. Ensuring that all such providers are able to confirm or obtain any authorization, if needed, for any such services from the Contractor; d. Honoring all prior authorizations and prior approvals for services for the duration of such prior authorizations and prior approvals or, if the Contractor chooses to modify or terminate a prior authorization and prior approval, then the Contractor must treat such modification or termination as an Adverse Action and follow the appeal rights policy and procedures, including notification to the Enrollee and the Enrollee’s provider in question; e. Ensuring appropriate medical record documentation or any continuity of care or transition plan activities as described in this Section; f. Ensuring that all Enrollees, including new Enrollees, may access Emergency Services at any emergency room, including from out-of-of- Network Providers, and that such Services are provided at no cost to the Enrollee, as described in Section 2.9; g. For Enrollees who have an existing prescription, providing any prescribed refills of such prescription, unless Contractor has a prior authorization policy as described in Section 2.6.B.1.c.2 and such policy requires a prior authorization for such prescription. If Contractor requires such prior authorization, Contractor shall, at a minimum, provide a 72 hour supply of such medication as described in Section 2.6.B.1.c.2; h. For pregnant Enrollees, the following: 1) If a pregnant Enrollee enrolls with the Contractor during a transition period after the Contract Effective Date, to be specified by EOHHS, such Enrollee may choose to remain with her current provider of obstetrical and gynecological services, even if such provider is not in the Contractor’s Provider Network; 2) The Contractor is required to cover all Medically Necessary obstetrical and gynecological services through delivery of the child, as well as immediate post-partum care and the follow-up appointments within the first six weeks of delivery, even if the provider of such services is not in the Contractor’s Provider Network; and 3) However, if a pregnant Enrollee would like to select a new Provider of obstetrician and gynecological services within the Contractor’s Provider Network, such Enrollee may do so; i. For Enrollees affiliated with other state agencies, coordination and consultation with such agencies as described in Sections 2.5.C and 2.6.F; j. For any Enrollee who is identified by EOHHS or by the Contractor as an Enrollee with Special Health Care Needs, completing a Transition Plan no later than 10 business days from the date the Contractor becomes aware of the Enrollee’s health status or condition, but in no case later than 45 days from the Effective Date of Enrollment. Such Transition Plan shall be specific to each such Enrollee’s needs, and shall include processes that address, at a minimum: 1) Medical record documentation; 2) Completion of a Care Needs Screening; 3) Evaluation for Care Management; 4) Coordination and consultation with the Enrollee’s existing Providers; 5) Review of all existing prior authorizations and prescriptions; and 6) Historical utilization data. k. Accepting and utilizing medical records, claims histories, and prior authorizations from an Enrollee’s previous Accountable Care Partnership Plan or MassHealth-contracted MCO. Provisions shall also include accepting and utilizing available medical records, claims histories, and prior authorizations from an Enrollee’s previous commercial carrier, to the extent such information is made available by the Enrollee, the Enrollee’s provider, or MassHealth. The process shall require the Contractor to, at a minimum: 1) Ensure that there is no interruption of ACO Covered Services for Enrollees; 2) Accept the transfer of all medical records and care management data, as directed by EOHHSXXXXX; 3) Accept the transfer of all administrative documentation, as directed by EOHHSXXXXX, including but not limited to: a) Provider Fraud investigations; b) Complaints from Enrollees; c) Grievances from Providers and Enrollees; d) Quality Management Plan; and e) Quality Improvement project records; l. Maintaining adequate staffing to fulfill all Contractual obligations throughout the duration of the Contract; m. As directed by EOHHSXXXXX, participating in any other activities determined necessary by EOHHS to ensure the continuity of care for Enrollees, including making best efforts to: 1) Outreach to New Enrollees within two business days of such New Enrollee’s Effective Date of Enrollment for a period at the start of the Contract to be specified by EOHHS and expected to last no more than 120 days from the Contract Operational Start Date. Such outreach may include telephone calls, mail, or email, as appropriate and compliant with all applicable laws; 2) Obtain any necessary consents from Members who were formerly Enrollees or Enrollees leaving the Contractor’s Plan, in order to transfer certain information specified by EOHHS to such Member’s or Enrollee’s new MassHealth Accountable Care Partnership Plan or MCO Plan; and 3) As directed by EOHHSXXXXX, transferring all information related to prior authorizations; n. For Enrollees actively receiving ABA Services for autism spectrum disorder, developing protocols to ensure continuity of these services for a minimum of 90 days after such Enrollee is enrolled with the Contractor. Such protocol shall include the use of single-case agreements, full acceptance and implementation of existing prior authorizations for ABA Services, and individual transition plans. 4. Shall, for new Enrollees enrolled pursuant to Section 2.7.A.1.o: a. Include all requirements in Section 2.2.C.1-4 for a period of 90 days following the Enrollee’s enrollment in the Contractor’s plan; b. For such Enrollees that have not transitioned to the Contractor’s Network Providers at the conclusion of such 90-day continuity of care period, include policies and procedures to ensure best efforts for providing uninterrupted care beyond the 90-day period. Such efforts shall include, but shall not be limited to, honoring authorizations from the Enrollee’s previous plan until the Contractor issues new authorizations for Medically Necessary services; paying out-of- network providers for services until such Enrollees have been transitioned to a Network Provider; and other measures as further specified by EOHHS; c. Include policies and procedures to ensure that the Contractor operates efficient provider credentialing processes to add Enrollees’ providers to the Contractor’s Provider Network, in accordance with all other applicable Contract requirements; and d. Include policies and procedures ensuring that the Contractor collaborates with and supports EOHHS in working with such Enrollees and their providers throughout and after the 90-day continuity of care period. Such collaboration and support shall include, but not be limited to, participating in Enrollee outreach, and identifying specific issues and working with EOHHS to resolve those issues. 5. Shall include designating a specific contact person to respond to EOHHS requests and concerns related to continuity of care. The Contractor shall provide EOHHS with such individual’s name, telephone number, and email address, and shall ensure such individual is available to EOHHS during business hours and at other times specified by EOHHS; and 65. Shall be submitted to EOHHS for approval on a date specified by EOHHS.