Common use of Continuity of Care Clause in Contracts

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 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- forfee-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 Care. OMPP is committed The Contractor shall implement mechanisms to providing ensure the continuity of care for of members as they transition between various IHCP programs transitioning in and out of the Hoosier Care Connect program and the Contractor’s enrollment. The Contractor Respondents shall have mechanisms in place to ensure the describe their proposed strategies for ensuring continuity of care and coordination of medically necessary health care services for its Hoosier Healthwise membersduring all transitions. The State emphasizes several critically important areas where the Contractor shall address continuity of care. Critical continuity of care areas Possible transitions between programs include, but are not limited to:   Initial enrollment with the Contractor;  Transitions between Hoosier Care Connect Contractors during the first ninety (90) days of enrollment or at any time for members receiving HIVcause;  Transition of Hoosier Care Connect wards and xxxxxx children when placement changes, Hepatitis C and/or behavioral health services, especially for those members who have received prior authorization from their previous MCE they enter the xxxxxx care system 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 coverageage out of xxxxxx care; and  A member’s transition  Transition to no coveragetraditional Medicaid due to receipt of an excluded service as described in Section 3.14. In situations such as a member or PMP disenrollmentDuring the first year of the Contract, the Contractor shall facilitate care coordination with other MCEs or other PMPs. When receiving members be required to honor outstanding authorizations for a minimum of ninety (90) calendar days when a member transitions to the Contractor from another MCE or fee-for-servicesource of coverage. Beginning one (1) year after the Contract effective date, the Contractor shall honor the previous care all outstanding authorizations for a minimum of thirty (30) calendar days days. Additionally, the Contractor shall maintain an individual’s case management stratification until a new assessment is completed when a member transitions from the member’s date Care Select program at the Contract start date, or from another Hoosier Care Connect Contractor at any time during the Contract term. More information on the assessment and stratification requirements are found in Section 5.0. During the first ninety (90) days of enrollment the Contract, the Contractor must allow a member who is receiving services from a non-network provider to continue receiving services from that provider, even if the network has been closed as described in Section 6.1 due to the Contractor meeting the network access requirements. The Contractor is permitted to establish single case agreements and shall make commercially reasonable attempts to contract with the Contractorproviders from whom an enrolled member is receiving ongoing care. The Contractor shall must establish policies and procedures for identifying outstanding prior authorization decisions and case management assignment 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 Care. OMPP FSSA 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 ninety (3090) 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 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- forfee-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 Care. OMPP FSSA 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- 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 ninety (3090) 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 Care. OMPP The State 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 HIP 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 HIP program from traditional fee- fee-for-service or HIPservic e;  ▪ A member’s transition between MCEs, particularly during an inpatient stay;  ▪ A member’s transition between IHCP programs, particularly when a HIP member becomes pregnant or disabled; ▪ A member’s transition following a medically frail determination; ▪ Members exiting the Hoosier Healthwise HIP 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;  PMP ▪ A member’s transition to private insurance or Marketplace coverage; and  ▪ A member’s transition to no coverage; and ▪ A member’s transition between HIP benefit plans (i.e. HIP Plus, HIP Basic, and HIP State Plan). 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-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. The 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 6.7 for additional requirements regarding continuity of care for behavioral health services, and Section 3.4 for additional requirements regarding continuity of care for pregnant members. The Hoosier Healthwise HIP MCE Policies and Procedures Manual describes the Contractor’s continuity and coordination of care responsibilities in more detail.

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 MCEsXXXx, 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 Care. OMPP The State 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 HIP 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 HIP program from traditional fee- fee-for-service or HIPservic e;  ▪ A member’s transition between MCEsXXXx, particularly during an inpatient stay;  ▪ A member’s transition between IHCP programs, particularly when a HIP member becomes pregnant or disabled; ▪ A member’s transition following a medically frail determination; ▪ Members exiting the Hoosier Healthwise HIP 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; and ▪ A member’s transition between HIP benefit plans (i.e. HIP Plus, HIP Basic, and HIP State Plan). 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 ninety (3090) calendar days from the member’s date of enrollment with the Contractor. The 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 3.7 for additional requirements regarding continuity of care for behavioral health services, and Section 12.4 for additional requirements regarding continuity of care for pregnant members. The Hoosier Healthwise HIP MCE Policies and Procedures Manual describes the Contractor’s continuity and coordination of care responsibilities in more detail.

Continuity of Care. OMPP The State 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 HIP 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 HIP program from traditional fee- fee-for-service or HIPservice;  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 servicesparticularly when a HIP member becomes pregnant or disabled;  A member’s transition following a medically frail determination;  Members exiting the Hoosier Healthwise HIP program to receive excluded services;  A member’s transition to a new PMP; PMP  A member’s transition to private insurance or Marketplace coverage; and  A member’s transition to no coverage; and  A member’s transition between HIP benefit plans (i.e. HIP Plus, HIP Basic, and HIP State Plan). 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. The 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 6.7 for additional requirements regarding continuity of care for behavioral health services, and Section 3.4 for additional requirements regarding continuity of care for pregnant members. The Hoosier Healthwise HIP MCE Policies and Procedures Manual describes the Contractor’s continuity and coordination of care responsibilities in more detail.

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 Care. OMPP FSSA 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- forfee-for- service or HIP;  ▪ A member’s transition between MCEsXXXx, 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 ninety (3090) 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 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- forfee-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 Care. OMPP is committed The Contractor shall implement mechanisms to providing ensure the continuity of care for of members as they transition between various IHCP programs transitioning in and out of the Hoosier Care Connect program and the Contractor’s enrollment. The Contractor Respondents shall have mechanisms in place to ensure the describe their proposed strategies for ensuring continuity of care and coordination of medically necessary health care services for its Hoosier Healthwise membersduring all transitions. The State emphasizes several critically important areas where the Contractor shall address continuity of care. Critical continuity of care areas Possible transitions between programs include, but are not limited to:   Initial enrollment with the Contractor;  Transitions between Hoosier Care Connect Contractors during the first ninety (90) days of enrollment or at any time for members receiving HIVcause;  Transition of Hoosier Care Connect wards and xxxxxx children when placement changes, Hepatitis C and/or behavioral health services, especially for those members who have received prior authorization from their previous MCE they enter the xxxxxx care system 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 coverageage out of xxxxxx care; and  A member’s transition  Transition to no coveragetraditional Medicaid due to receipt of an excluded service as described in Section 3.14. In situations such as a member or PMP disenrollmentDuring the first year of the Contract, the Contractor shall facilitate care coordination with other MCEs or other PMPs. When receiving members be required to honor outstanding authorizations for a minimum of ninety (90) calendar days when a member transitions to the Contractor from another MCE or fee-for-servicesource of coverage. Beginning one (1) year after the Contract effective date, the Contractor shall honor the previous care all outstanding authorizations for a minimum of thirty (30) calendar days days. Additionally, the Contractor shall maintain an individual’s case management stratification until a new assessment is completed when a member transitions from the member’s date Care Select program at the Contract start date, or from another Hoosier Care Connect Contractor at any time during the Contract term. More information on the assessment and stratification requirements are found in Section 5.0. During the first ninety (90) days of enrollment the Contract, the Contractor must allow a member who is receiving services from a non-network provider to continue receiving services from that provider, even if the network has been closed as described in Section 6.1 due to the Contractor meeting the network access requirements. The Contractor is permitted to EXHIBIT 1.M SCOPE OF WORK establish single case agreements and shall make commercially reasonable attempts to contract with the Contractorproviders from whom an enrolled member is receiving ongoing care. The Contractor shall must establish policies and procedures for identifying outstanding prior authorization decisions and case management assignment 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 Care. OMPP The State 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 HIP 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 HIP program from traditional fee- fee-for-service or HIPservice;  ▪ A member’s transition between MCEs, particularly during an inpatient stay;  ▪ A member’s transition between IHCP programs, particularly when a HIP member becomes pregnant or disabled; ▪ A member’s transition following a medically frail determination; ▪ Members exiting the Hoosier Healthwise HIP 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;  PMP ▪ A member’s transition to private insurance or Marketplace coverage; and  ▪ A member’s transition to no coverage; and ▪ A member’s transition between HIP benefit plans (i.e. HIP Plus, HIP Basic, and HIP State Plan). 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. The 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 6.7 for additional requirements regarding continuity of care for behavioral health services, and Section 3.4 for additional requirements regarding continuity of care for pregnant members. The Hoosier Healthwise HIP MCE Policies and Procedures Manual describes the Contractor’s continuity and coordination of care responsibilities in more detail.

Continuity of Care. OMPP The State 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 HIP 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 HIP program from traditional fee- fee-for-service or HIPservic e;  ▪ A member’s transition between MCEsXXXx, particularly during an inpatient stay;  ▪ A member’s transition between IHCP programs, particularly when a HIP member becomes pregnant or disabled; ▪ A member’s transition following a medically frail determination; ▪ Members exiting the Hoosier Healthwise HIP 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; and ▪ A member’s transition between HIP benefit plans (i.e. HIP Plus, HIP Basic, and HIP State Plan). 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 ninety (3090) calendar days from the member’s date of enrollment with the Contractor. The 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. Stat e. 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 3.7 for additional requirements regarding continuity of care for behavioral health services, and Section 12.4 for additional requirements regarding continuity of care for pregnant members. The Hoosier Healthwise HIP MCE Policies and Procedures Manual describes the Contractor’s continuity and coordination of care responsibilities in more detail.

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 HIP 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 HIP program from traditional fee- fee-for-service or HIPservice;   A member’s transition between MCEs, particularly during an inpatient stay;   A member’s transition between IHCP programs, particularly when a HIP member becomes pregnant or disabled;  A member’s transition following a medically frail determination;  Members exiting the Hoosier Healthwise HIP 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;  PMP  A member’s transition to private insurance or Marketplace coverage; and   A member’s transition to HIP Link coverage;  A member’s transition to no coverage; and  A member’s transition between HIP benefit plans (i.e. HIP Plus, HIP Basic, and HIP State Plan). 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. The 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 6.7 for additional requirements regarding continuity of care for behavioral health services, and Section 3.4 for additional requirements regarding continuity of care for pregnant members. The Hoosier Healthwise HIP MCE Policies and Procedures Manual describes the Contractor’s continuity and coordination of care responsibilities in more detail.

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 rogram from traditional fee- forfee-for- service or HIP;  A member’s transition between MCEs, particularly during an inpatient stayHealthwise program to receive excluded services;  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 terminatesinates. 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.the

Continuity of Care. OMPP FSSA 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- fee-for-service or HIP;  ▪ A member’s transition between MCEsXXXx, 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-fee- for-service, the Contractor shall honor the previous care authorizations for a minimum of thirty ninety (3090) 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 Care. OMPP The State 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 HIP 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 HIP program from traditional fee- fee-for-service or HIPservic e;  ▪ A member’s transition between MCEsXXXx, particularly during an inpatient stay;  ▪ A member’s transition between IHCP programs, particularly when a HIP member becomes pregnant or disabled; ▪ A member’s transition following a medically frail determination; ▪ Members exiting the Hoosier Healthwise HIP 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; and ▪ A member’s transition between HIP benefit plans (i.e. HIP Plus, HIP Basic, and HIP State Plan). 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 ninety (3090) calendar days from the member’s date of enrollment with the Contractor. The 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 t he 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 3.7 for additional requirements regarding continuity of care for behavioral health services, and Section 12.4 for additional requirements regarding continuity of care for pregnant members. The Hoosier Healthwise HIP MCE Policies and Procedures Manual describes the Contractor’s continuity and coordination of care responsibilities in more detail.