Continuity of Care & Re-entry Services Sample Clauses

Continuity of Care & Re-entry Services. In collaboration with the Behavioral Healthcare Contractor, the Pharmacy Contractor, and BHSAMH, the Provider shall actively participate in comprehensive re-entry coordination aimed at successfully re-assimilating patients into the community. The purpose of this is to ensure continuity of healthcare and access to social services for released patients. The Provider shall have designated staff at each facility that have as part of their responsibilities, the oversight of the medical aspects of re-entry and participation in the re- entry and discharge planning teams at each facility. These designated staff should work flexible schedules to allow for appropriate reentry and discharge services that occur outside of regular business hours. See BHSAMH Policy E-10 Discharge Planning and DDOC Policy 3.12 Reentry Planning Policy, Case Logic Model and Collaborative Case Management Model for more information on these services. Discharge planning begins on admission and occurs at all transitions of care, including but not limited to intra-system transfers, transfer to and from community-based healthcare facilities, transfers to and from correctional facilities in other jurisdictions, discharges from custody, and re-admission to DDOC. In accordance with BHSAMH Policies E-09 Continuity, Coordination, and Quality of Care During Incarceration and E-10 Discharge Planning, and the DDOC Reentry Planning Policy, the Provider shall ensure that a robust system is in place to ensure continuity of care within and between DDOC facilities and between DDOC facilities and external healthcare facilities and providers. The Provider shall provide both statewide and facility level positions that have as part of their responsibility’s reentry care coordination and the oversight of continuity of care practices upon admission, transfer, and discharge from DDOC. The Provider shall provide discharge nurses to assist with medical aspects of discharge and reentry in collaboration with the reentry and behavioral healthcare staff from the behavioral healthcare contract.
Sample 1
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Continuity of Care & Re-entry Services. In collaboration with the behavioral health staff, the Pharmacy Contractor and the DDOC, Provider shall actively participate in comprehensive re-entry coordination aimed at successfully re-assimilating Inmates into the community. The purpose of this program is to ensure continuity of healthcare and access to social services for released Inmates. Provider shall have designated staff at each facility that have, as part of their responsibilities, the oversight of the medical aspects of re- entry and participation in the re-entry and discharge planning teams at each facility. Continuity of care begins at admission and occurs at all transitions of care, including but not limited to intra-system transfers, transfer from and to community-based healthcare facilities, transfers to and from correctional facilities in other jurisdictions, discharges from custody, and re-admission to the DDOC. Provider shall, in accordance with DDOC Policies E-09 Continuity, Coordination, and Quality of Care During Incarceration, 11-E-10 Discharge Planning and DDOC Reentry Planning Policy, ensure that a robust system is in place to ensure continuity of care within and between DDOC facilities and between DDOC facilities and external healthcare facilities and providers. Provider shall provide both statewide and facility-level positions that have, as part of their responsibilities, reentry care coordination and the oversight of continuity of care practices upon admission, transfer, and discharge from DDOC. Provider shall:
Sample 1

Related to Continuity of Care & Re-entry Services

  • Continuity of Care OMPP is committed to providing continuity of care for members as they transition between various IHCP programs and the Contractor’s enrollment. The Contractor shall have mechanisms in place to ensure the continuity of care and coordination of medically necessary health care services for its Hoosier Healthwise members. The State emphasizes several critically important areas where the Contractor shall address continuity of care. Critical continuity of care areas include, but are not limited to:  Transitions for members receiving HIV, Hepatitis C and/or behavioral health services, especially for those members who have received prior authorization from their previous MCE or through fee-for-service;  Transitions for members who are pregnant;  A member’s transition into the Hoosier Healthwise program from traditional fee- for-service or HIP;  A member’s transition between MCEs, particularly during an inpatient stay;  A member’s transition between IHCP programs, Members exiting the Hoosier Healthwise program to receive excluded services;  A member’s exiting the Hoosier Healthwise program to receive excluded services;  A member’s transition to a new PMP;  A member’s transition to private insurance or Marketplace coverage; and  A member’s transition to no coverage. In situations such as a member or PMP disenrollment, the Contractor shall facilitate care coordination with other MCEs or other PMPs. When receiving members from another MCE or fee-for-service, the Contractor shall honor the previous care authorizations for a minimum of thirty (30) calendar days from the member’s date of enrollment with the Contractor. Contractor shall establish policies and procedures for identifying outstanding prior authorization decisions at the time of the member’s enrollment in their plan. For purposes of clarification, the date of member enrollment for purposes of the prior authorization time frames set forth in this section begin on the date the Contractor receives the member’s fully eligible file from the State. Additionally, when a member transitions to another source of coverage, the Contractor shall be responsible for providing the receiving entity with information on any current service authorizations, utilization data and other applicable clinical information such as disease management, case management or care management notes. This process shall be overseen by the Transition Coordination Manager. The Contractor will be responsible for care coordination after the member has disenrolled from the Contractor whenever the member disenrollment occurs during an inpatient stay. In these cases, the Contractor will remain financially responsible for the hospital DRG payment and any outlier payments (without a capitation payment) until the member is discharged from the hospital or the member’s eligibility in Medicaid terminates. The Contractor shall coordinate discharge plans with the member’s new MCE. See Section 3.7.5 for additional requirements regarding continuity of care for behavioral health services. The Hoosier Healthwise MCE Policies and Procedures Manual describes the Contractor’s continuity and coordination of care responsibilities in more detail.

  • Continuity of Services A. The Contractor recognizes that the service(s) to be performed under this Contract are vital to the State and must be continued without interruption and that, upon Contract expiration, a successor, either the State or another contractor, may continue them. The Contractor agrees to:

  • Prevention Care Services and Early Detection Services See Prevention and Early Detection Services section for details. 0% Not Covered Private Duty Nursing Services* Must be performed by a certified home health care agency. 0% - After deductible Not Covered

  • Preventive Care and Early Detection Services This plan covers, early detection services, preventive care services, and immunizations or vaccinations in accordance with state and federal law, including the Affordable Care Act (ACA), as set forth below and in accordance with the guidelines of the following resources: • services that have an A or B rating in the current recommendations of the U.S. Preventative Services Task Force (USPSTF); • immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention; • preventive care and screenings for infants, children, and adolescents as outlined in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA); or • preventive care and screenings for women as outlined in the comprehensive guidelines as supported by HRSA. Covered early detection services, preventive care services and adult and pediatric immunizations or vaccinations are based on the most currently available guidelines and are subject to change. The amount you pay for preventive services will be different from the amount you pay for diagnostic procedures and non-preventive services. See the Summary of Medical Benefits and the Summary of Pharmacy Benefits for more information about the amount you pay. Preventive Office Visits This plan covers the following preventive office visits. • Annual preventive visit - one (1) routine physical examination per plan year per member age 36 months and older; • Pediatric preventive office and clinic visits from birth to 35 months - 11 visits; • Well Woman annual preventive visit - one (1) routine gynecological examination per plan year per female member.

  • Continuity of Service Except where there exists an emergency situation necessitating a more expeditious procedure, the Licensee shall use reasonable efforts to interrupt service for the purpose of Cable Communications System construction, routine repairing or testing the Cable System only during periods of minimum use. When necessary service interruptions can be anticipated, the Licensee shall notify Subscribers in advance via message on the community channel community bulletin board.

  • Hospice Services Services are available for a Member whose Attending Physician has determined the Member's illness will result in a remaining life span of six months or less.

  • Outpatient emergency and urgicenter services within the service area The emergency room copay applies to all outpatient emergency visits that do not result in hospital admission within twenty-four (24) hours. The urgicenter copay is the same as the primary care clinic office visit copay.

  • Emergency Care Services If you experience a medical emergency while traveling outside our service area, go to the nearest emergency or urgent care facility. When you receive Out-of-Area covered healthcare services outside our service area and the claim is processed through the BlueCard Program, the amount you pay for the Out-of-Area Covered healthcare services, if not a flat dollar copayment, is calculated based on the lower of: • the billed charges for your Out-of-Area covered healthcare services; or • the negotiated price that the Host Blue makes available to us. Often, this “negotiated price” will be a simple discount that reflects an actual price that the Host Blue pays to your healthcare provider. Sometimes, it is an estimated price that takes into account special arrangements with your healthcare provider or provider group that may include types of settlements, incentive payments and/or other credits or charges. Occasionally, it may be an average price, based on a discount that results in expected average savings for similar types of healthcare providers after taking into account the same types of transactions as with an estimated price. Estimated pricing and average pricing also take into account adjustments to correct for over- or underestimation of past pricing of claims, as noted above. However, such adjustments will not affect the price we have used for your claim because they will not be applied after a claim has already been paid. Negotiated (non–BlueCard Program) Arrangements With respect to one or more Host Blues, in certain instances, instead of using the BlueCard Program, we may process your claims for covered healthcare services through Negotiated Arrangements for National Accounts. The amount you pay for covered healthcare services under this arrangement will be calculated based on the negotiated price (refer to the description of negotiated price in the BlueCard® Program section above) made available to us by the Host Blue.

  • Continuity of Grievance Notwithstanding the expiration of this Agreement, any claim or grievance arising hereunder may be processed through the grievance procedure until resolution.

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