Common use of Coordination and Continuity of Care Clause in Contracts

Coordination and Continuity of Care. 1. In addition to meeting the coordination and continuity of care requirements set forth in Article II.E.3, the Contractor shall develop a care coordination plan that provides for seamless transitions of care for beneficiaries with the DMC-ODS system of care. Contractor is responsible for developing a structured approach to care coordination to ensure that beneficiaries successfully transition between levels of SUD care (i.e. withdrawal management, residential, outpatient) without disruptions to services. 2. In addition to specifying how beneficiaries will transition across levels of acute and short-term SUD care without gaps in treatment, the Contractor shall ensure that beneficiaries have access to recovery supports and services immediately after discharge or upon completion of an acute care stay, with the goal of sustained engagement and long- term retention in SUD and behavioral health treatment. 3. Contractor shall enter into a Memorandum Of Understanding (MOU) with any Medi-Cal managed care plan that enrolls beneficiaries served by the DMC-ODS. This requirement may be met through an amendment to the Specialty Mental Health Managed Care Plan MOU. i. The following elements in the MOU should be implemented at the point of care to ensure clinical integration between DMC-ODS and managed care providers: a. Comprehensive substance use, physical, and mental health screening. b. Beneficiary engagement and participation in an integrated care program as needed; c. Shared development of care plans by the beneficiary, caregivers and all providers; d. Collaborative treatment planning with managed care; e. Delineation of case management responsibilities; f. A process for resolving disputes between the county and the Medi-Cal managed care plan that includes a means for beneficiaries to receive medically necessary services while the dispute is being resolved; g. Availability of clinical consultation, including consultation on medications; h. Care coordination and effective communication among providers including procedures for exchanges of medical information; i. Navigation support for patients and caregivers; and j. Facilitation and tracking of referrals between systems including bidirectional referral protocol.

Coordination and Continuity of Care. 1. In addition to meeting the coordination and continuity of care requirements set forth in Article II.E.3, the Contractor shall develop a care coordination plan that provides for seamless transitions of care for beneficiaries with the DMC-ODS system of care. Contractor is responsible for developing a structured approach to care coordination to ensure that beneficiaries successfully transition between levels of SUD care (i.e. withdrawal management, residential, outpatient) without disruptions to services. 2. In addition to specifying how beneficiaries will transition across levels of acute and short-term SUD care without gaps in treatment, the Contractor shall ensure that beneficiaries have access to recovery supports and services immediately after discharge or upon completion of an acute care stay, with the goal of sustained engagement and long- long-term retention in SUD and behavioral health treatment. 3. Contractor shall enter into a Memorandum Of Understanding (MOU) with any Medi-Cal managed care plan that enrolls beneficiaries served by the DMC-ODS. This requirement may be met through an amendment to the Specialty Mental Health Managed Care Plan MOU. i. The following elements in the MOU should be implemented at the point of care to ensure clinical integration between DMC-ODS and managed care providers: a. Comprehensive substance use, physical, and mental health screening. b. Beneficiary engagement and participation in an integrated care program as needed; c. Shared development of care plans by the beneficiary, caregivers and all providers; d. Collaborative treatment planning with managed care; e. Delineation of case management responsibilities; f. A process for resolving disputes between the county and the Medi-Cal managed care plan that includes a means for beneficiaries to receive medically necessary services while the dispute is being resolved; g. Availability of clinical consultation, including consultation on medications; h. Care coordination and effective communication among providers including procedures for exchanges of medical information; i. Navigation support for patients and caregivers; and j. Facilitation and tracking of referrals between systems including bidirectional referral protocol.