Common use of Coordination of Care Clause in Contracts

Coordination of Care. The PH-MCO must coordinate care for its Members. The PH-MCO must provide for seamless and continuous coordination of care across a continuum of services for the Member with a focus on improving health care outcomes. The continuum of services may include the In-Plan comprehensive service package, out-of-plan services, and non-MA covered services provided by other community resources such as: • Nursing Facility Care • Intermediate Care Facility for the Intellectually Disabled/Other Related Conditions • Residential Treatment Facility • Acute Psychiatric Facilities • Extended and Extended Acute Psychiatric Facilities • Non-Hospital Residential Detoxification, Rehabilitation, and Half- Way House Facilities for Drug/Alcohol Dependence/ Addiction • Opioid Use Disorder Centers of Excellence • Aging Well PA/Level of Care Assessment and Pre-admission Screening Requirements • Juvenile Detention Centers • Children in Substitute Care Transition • Adoption Assistance for Children and Adolescents • Services to Dual Eligibles Under the Age of Twenty-one • Transitional Care Homes • Medical Xxxxxx Care Services • Early Intervention Services (note the PH-MCO must refer for Early Intervention Services any of its Members who are children from birth to age three (3) who are living in residential facilities. “Children living in residential facilities” describes children who are in a 24-hour living setting in which care is provided for one or more children.) • The OBRA waiver, a home-and-community-based waiver program for individuals who have a severe developmental physical disability requiring an Intermediate Care Facility/Other Related Conditions (ICF/ORC) level of care • Intellectual Disabilities Services (note the PH-MCO is responsible to ensure a family with a child who has or is at risk of a developmental delay is referred to the County Intellectual Disabilities office for a determination of eligibility for home and community-based services, including children living in residential facilities as described above.) • Home-and Community-Based Waiver for Persons with Intellectual Disabilities • Children in Residential Facilities • Home-and Community-Based Waiver for Persons with Autism The PH-MCO must provide the necessary related services for Members in facilities as described in Exhibit O, Description of Facilities and Related Services. Out-of-Plan Services are described in Exhibit P, Out-of-Plan Services. Recipient coverage rules are outlined in Exhibit BB, PH-MCO Recipient Coverage Document.

Coordination of Care. The PH-MCO must coordinate is responsible for coordination of care for its Membersindividuals enrolled in HealthChoices. The PH-MCO must provide for ensure seamless and continuous coordination of care across a continuum of services for the individual Member with a focus on improving health care outcomes. The continuum of services may include the Inin-Plan plan comprehensive service benefits package, out-of-plan servicesbenefits, and non-MA covered services provided by other community resources such as: •  Nursing Facility Care •  Intermediate Care Facility for the Intellectually DisabledMentally Retarded/Other Related Conditions • (ICF/MR/ORC)  Residential Treatment Facility • (RTF)  Acute Psychiatric Facilities •  Extended and and/or Extended Acute Psychiatric Facilities •  Non-Hospital Residential Detoxification, Rehabilitation, and Half- Half-Way House Facilities for Drug/Alcohol Dependence/ Addiction • Opioid Use Disorder Centers of Excellence •  Area Agencies on Aging Well PA/Level of Care (AAA)/OPTIONS Assessment and Pre-Pre- admission Screening Requirements •  Pennsylvania Department of Aging (PDA) Waiver  Juvenile Detention Centers • (JDCs)  Children in Substitute Care Transition •  Adoption Assistance for Children and Children/Adolescents •  Services to Dual Eligibles Under the Age of Twenty-one •  Transitional Care Homes •  Medical Xxxxxx Care Services •  Early Intervention Services (note that the PH-MCO must refer for Early Intervention Services any of its Members members who are children from birth to age three (3) who are living in residential facilities. “Children living in residential facilities” describes children who are in a 24-hour living setting in which care is provided for one or more children.) • The OBRA waiver, a home-and-community-based waiver program  Home and Community Based Waiver Program for individuals who have a severe developmental physical disability requiring an Intermediate Care Facility/Nursing Facility Residents with Other Related Conditions (ICFOSP/ORCOBRA Waiver) level of care • Intellectual Disabilities  Home and Community Based Waiver Program for Nursing Facility Applicants with Other Related Conditions (OSP/Independence Waiver)  Home and Community Based Waiver for Attendant Care Services (note the PH-MCO is responsible to ensure a family with a child who has or is at risk of a developmental delay is referred to the County Intellectual Disabilities office for a determination of eligibility for home OSP/AC Waiver)  Home and community-based services, including children living in residential facilities as described above.) • Home-and Community-Community Based Waiver for Persons with Intellectual Disabilities • Children in Residential Facilities • Home-and Community-Based Mental Retardation  COMMCARE Waiver for Persons with Autism a Primary Diagnosis of Traumatic Brain Injury The PH-MCO must provide the necessary related HealthChoices Program requirements covering special services for Members in facilities as described are outlined in Exhibit OO of this Agreement, Description of Facilities and Related Services. Out-of-Plan Services are described in Exhibit PP of this Agreement, Out-of-Plan Services. Recipient coverage rules are outlined in Exhibit BB, PH-MCO Recipient Coverage Document.

Coordination of Care. The PH-MCO must coordinate care for its Members. The PH-MCO must provide for seamless and continuous coordination of care across a continuum of services for the Member with a focus on improving health care outcomes. The continuum of services may include the In-Plan comprehensive service package, out-of-plan services, and non-MA covered services provided by other community resources such as: • Nursing Facility Care • Intermediate Care Facility for the Intellectually Disabled/Other Related Conditions • Residential Treatment Facility • Acute Psychiatric Facilities • Extended and Extended Acute Psychiatric Facilities • Non-Hospital Residential Detoxification, Rehabilitation, and Half- Way House Facilities for Drug/Alcohol Dependence/ Addiction • Opioid Use Disorder Centers of Excellence • Aging Well PA/Level of Care Assessment and Pre-admission Screening Requirements • Juvenile Detention Centers • Children in Substitute Care Transition • Adoption Assistance for Children and Adolescents • Services to Dual Eligibles Under the Age of Twenty-one • Transitional Care Homes • Medical Xxxxxx Care Services • Early Intervention Services (note the PH-MCO must refer for Early Intervention Services any of its Members who are children from birth to age three (3) who are living in residential facilities. “Children living in residential facilities” describes children who are in a 24-hour living setting in which care is provided for one or more children.) • The OBRA waiver, a home-and-community-based waiver program for individuals who have a severe developmental physical disability requiring an Intermediate Care Facility/Other Related Conditions (ICF/ORC) level of care • Intellectual Disabilities Services (note the PH-MCO is responsible to ensure a family with a child who has or is at risk of a developmental delay is referred to the County Intellectual Disabilities office for a determination of eligibility for home and community-based services, including children living in residential facilities as described above.) • Home-and Community-Based Waiver for Persons with Intellectual Disabilities • Children in Residential Facilities • Home-and Community-Based Waiver for Persons with Autism The PH-MCO must provide the necessary related services for Members in facilities as described in Exhibit O, Description of Facilities and Related Services. Out-of-Plan Services are described in Exhibit P, Out-of-Plan Services. Recipient coverage rules are outlined in Exhibit BB, PH-MCO Recipient Coverage Document.

Coordination of Care. ‌ The PH-MCO must coordinate is responsible for coordination of care for its Membersindividuals enrolled in HealthChoices. The PH-MCO must provide for ensure seamless and continuous coordination of care across a continuum of services for the individual Member with a focus on improving health care outcomes. The continuum of services may include the Inin-Plan plan comprehensive service benefits package, out-of-plan servicesbenefits, and non-MA covered services provided by other community resources such as: • Nursing Facility Care • Intermediate Care Facility for the Intellectually Disabled/Other Related Conditions (ICF/ ID/ORC) • Residential Treatment Facility (RTF) • Acute Psychiatric Facilities • Extended and and/or Extended Acute Psychiatric Facilities • Non-Hospital Residential Detoxification, Rehabilitation, and Half- Half-Way House Facilities for Drug/Alcohol Dependence/ Addiction • Opioid Use Disorder Centers of Excellence • Area Agencies on Aging Well PA/Level of Care (AAA)/OPTIONS Assessment and Pre-Pre- admission Screening Requirements • Pennsylvania Department of Aging (PDA) Waiver • Juvenile Detention Centers (JDCs) • Children in Substitute Care Transition • Adoption Assistance for Children and Children/Adolescents • Services to Dual Eligibles Under the Age of Twenty-one • Transitional Care Homes • Medical Xxxxxx Care Services • Early Intervention Services (note that the PH-MCO must refer for Early Intervention Services any of its Members members who are children from birth to age three (3) who are living in residential facilities. “Children living in residential facilities” describes children who are in a 24-hour living setting in which care is provided for one or more children.) • The OBRA waiver, a home-and-community-based waiver program Home and Community Based Waiver Program for individuals who have a severe developmental physical disability requiring an Intermediate Care Facility/Nursing Facility Residents with Other Related Conditions (ICFOLTL/ORCOBRA Waiver) level of care • Intellectual Disabilities Home and Community Based Waiver Program for Nursing Facility Applicants with Other Related Conditions (OLTL/Independence Waiver) • Home and Community Based Waiver for Attendant Care Services (note the PH-MCO is responsible to ensure a family with a child who has or is at risk of a developmental delay is referred to the County Intellectual Disabilities office for a determination of eligibility for home and community-based services, including children living in residential facilities as described above.OLTL/AC Waiver) • Home-Home and Community-Community Based Waiver for Persons with Intellectual Disabilities • Children in Residential Facilities • Home-and Community-Based COMMCARE Waiver for Persons with Autism a Primary Diagnosis of Traumatic Brain Injury The PH-MCO must provide the necessary related HealthChoices Program requirements covering special services for Members in facilities as described are outlined in Exhibit OO of this Agreement, Description of Facilities and Related Services. Out-of-Plan Services are described in Exhibit PP of this Agreement, Out-of-Plan Services. Recipient coverage rules are outlined in Exhibit BB, PH-MCO Recipient Coverage Document.

Coordination of Care. ‌ The PH-MCO must coordinate is responsible for coordination of care for its Membersindividuals enrolled in HealthChoices. The PH-MCO must provide for ensure seamless and continuous coordination of care across a continuum of services for the individual Member with a focus on improving health care outcomes. The continuum of services may include the Inin-Plan plan comprehensive service benefits package, out-of-plan servicesbenefits, and non-MA covered services provided by other community resources such as: •  Nursing Facility Care •  Intermediate Care Facility for the Intellectually Disabled/Other Related Conditions • (ICF/ ID/ORC)  Residential Treatment Facility • (RTF)  Acute Psychiatric Facilities •  Extended and and/or Extended Acute Psychiatric Facilities •  Non-Hospital Residential Detoxification, Rehabilitation, and Half- Half-Way House Facilities for Drug/Alcohol Dependence/ Addiction • Opioid Use Disorder Centers of Excellence •  Area Agencies on Aging Well PA/Level of Care (AAA)/OPTIONS Assessment and Pre-Pre- admission Screening Requirements •  Pennsylvania Department of Aging (PDA) Waiver  Juvenile Detention Centers • (JDCs)  Children in Substitute Care Transition •  Adoption Assistance for Children and Children/Adolescents •  Services to Dual Eligibles Under the Age of Twenty-one •  Transitional Care Homes •  Medical Xxxxxx Care Services •  Early Intervention Services (note that the PH-MCO must refer for Early Intervention Services any of its Members members who are children from birth to age three (3) who are living in residential facilities. “Children living in residential facilities” describes children who are in a 24-hour living setting in which care is provided for one or more children.) • The OBRA waiver, a home-and-community-based waiver program  Home and Community Based Waiver Program for individuals who have a severe developmental physical disability requiring an Intermediate Care Facility/Nursing Facility Residents with Other Related Conditions (ICFOLTL/ORCOBRA Waiver) level of care • Intellectual Disabilities  Home and Community Based Waiver Program for Nursing Facility Applicants with Other Related Conditions (OLTL/Independence Waiver)  Home and Community Based Waiver for Attendant Care Services (note the PH-MCO is responsible to ensure a family with a child who has or is at risk of a developmental delay is referred to the County Intellectual Disabilities office for a determination of eligibility for home OLTL/AC Waiver)  Home and community-based services, including children living in residential facilities as described above.) • Home-and Community-Community Based Waiver for Persons with Intellectual Disabilities • Children in Residential Facilities • Home-and Community-Based  COMMCARE Waiver for Persons with Autism a Primary Diagnosis of Traumatic Brain Injury The PH-MCO must provide the necessary related HealthChoices Program requirements covering special services for Members in facilities as described are outlined in Exhibit OO of this Agreement, Description of Facilities and Related Services. Out-of-Plan Services are described in Exhibit PP of this Agreement, Out-of-Plan Services. Recipient coverage rules are outlined in Exhibit BB, PH-MCO Recipient Coverage Document.

Coordination of Care. The PH-MCO must coordinate is responsible for coordination of care for its Membersindividuals enrolled in HealthChoices. The PH-MCO must provide for ensure seamless and continuous coordination of care across a continuum of services for the individual Member with a focus on improving health care outcomes. The continuum of services may include the Inin-Plan plan comprehensive service benefits package, out-of-plan servicesbenefits, and non-MA covered services provided by other community resources such as: • Nursing Facility Care • Intermediate Care Facility for the Intellectually DisabledMentally Retarded/Other Related Conditions (ICF/MR/ORC) • Residential Treatment Facility (RTF) • Acute Psychiatric Facilities • Extended and and/or Extended Acute Psychiatric Facilities • Non-Hospital Residential Detoxification, Rehabilitation, and Half- Half-Way House Facilities for Drug/Alcohol Dependence/ Addiction • Opioid Use Disorder Centers of Excellence • Area Agencies on Aging Well PA/Level of Care (AAA)/OPTIONS Assessment and Pre-Pre- admission Screening Requirements • Pennsylvania Department of Aging (PDA) Waiver • Juvenile Detention Centers (JDCs) • Children in Substitute Care Transition • Adoption Assistance for Children and Children/Adolescents • Services to Dual Eligibles Under the Age of Twenty-one • Transitional Care Homes • Medical Xxxxxx Care Services • Early Intervention Services (note that the PH-MCO must refer for Early Intervention Services any of its Members members who are children from birth to age three (3) who are living in residential facilities. “Children living in residential facilities” describes children who are in a 24-hour living setting in which care is provided for one or more children.) • The OBRA waiver, a home-and-community-based waiver program Home and Community Based Waiver Program for individuals who have a severe developmental physical disability requiring an Intermediate Care Facility/Nursing Facility Residents with Other Related Conditions (ICFOSP/ORCOBRA Waiver) level of care • Intellectual Disabilities Home and Community Based Waiver Program for Nursing Facility Applicants with Other Related Conditions (OSP/Independence Waiver) • Home and Community Based Waiver for Attendant Care Services (note the PH-MCO is responsible to ensure a family with a child who has or is at risk of a developmental delay is referred to the County Intellectual Disabilities office for a determination of eligibility for home and community-based services, including children living in residential facilities as described above.OSP/AC Waiver) • Home-Home and Community-Community Based Waiver for Persons with Intellectual Disabilities Mental Retardation • Children in Residential Facilities • Home-and Community-Based COMMCARE Waiver for Persons with Autism a Primary Diagnosis of Traumatic Brain Injury The PH-MCO must provide the necessary related HealthChoices Program requirements covering special services for Members in facilities as described are outlined in Exhibit OO of this Agreement, Description of Facilities and Related Services. Out-of-Plan Services are described in Exhibit PP of this Agreement, Out-of-Plan Services. Recipient coverage rules are outlined in Exhibit BB, PH-MCO Recipient Coverage Document.

Coordination of Care. ‌ The PH-MCO must coordinate care for its Members. The PH-MCO must provide for seamless and continuous coordination of care across a continuum of services for the Member with a focus on improving health care outcomes. The continuum of services may include the In-Plan comprehensive service package, out-of-plan services, and non-MA covered services provided by other community resources such as: •  Nursing Facility Care •  Intermediate Care Facility for the Intellectually Disabled/Other Related Conditions •  Residential Treatment Facility •  Acute Psychiatric Facilities •  Extended and Extended Acute Psychiatric Facilities •  Non-Hospital Residential Detoxification, Rehabilitation, and Half- Way House Facilities for Drug/Alcohol Dependence/ Addiction •  Opioid Use Disorder Centers of Excellence • Aging Well PA AAA/Level of Care Assessment Functional Eligibility Determination and Pre-admission Screening Requirements •  PDA Waiver  Juvenile Detention Centers •  Children in Substitute Care Transition •  Adoption Assistance for Children and Adolescents •  Services to Dual Eligibles Under the Age of Twenty-one •  Transitional Care Homes •  Medical Xxxxxx Care Services •  Early Intervention Services (note that the PH-MCO must refer for Early Intervention Services any of its Members who are children from birth to age three (3) who are living in residential facilities. “Children living in residential facilities” describes children who are in a 24-hour living setting in which care is provided for one or more children.) • The OBRA waiver, a home Home-andand Community-community-based waiver program Based Waiver Program for individuals who have a severe developmental physical disability requiring an Intermediate Care Facility/Nursing Facility Residents with Other Related Conditions (ICF/ORC) level of care • Intellectual Disabilities  Home-and Community-Based Waiver Program for Nursing Facility Applicants with Other Related Conditions  Home-and Community-Based Waiver for Attendant Care Services (note the PH-MCO is responsible to ensure a family with a child who has or is at risk of a developmental delay is referred to the County Intellectual Disabilities office for a determination of eligibility for home and community-based services, including children living in residential facilities as described above.) •  Home-and Community-Based Waiver for Persons with Intellectual Disabilities •  COMMCARE Waiver for Persons with a Primary Diagnosis of Acquired Brain Injury  Children in Residential Facilities •  Home-and Community-Based Waiver for Persons with Autism The PH-MCO must provide the necessary related services for Members in facilities as described in Exhibit O, Description of Facilities and Related Services. Out-of-Plan Services are described in Exhibit P, Out-of-Plan Services. Recipient coverage rules are outlined in Exhibit BB, PH-MCO Recipient Coverage Document.

Coordination of Care. The PH-MCO must coordinate care for its Members. The PH-MCO must provide for seamless and continuous coordination of care across a continuum of services for the Member with a focus on improving health care outcomes. The continuum of services may include the In-Plan comprehensive service package, out-of-plan services, and non-MA covered services provided by other community resources such as: • Nursing Facility Care • Intermediate Care Facility for the Intellectually Disabled/Other Related Conditions • Residential Treatment Facility • Acute Psychiatric Facilities • Extended and Extended Acute Psychiatric Facilities • Non-Hospital Residential Detoxification, Rehabilitation, and Half- Half-Way House Facilities for Drug/Alcohol Dependence/ Addiction • Opioid Use Disorder Centers of Excellence • Aging Well PAAAA/Level of Care OPTIONS Assessment and Pre-admission Screening Requirements • PDA Waiver • Juvenile Detention Centers • Children in Substitute Care Transition • Adoption Assistance for Children and Adolescents • Services to Dual Eligibles Under the Age of Twenty-one • Transitional Care Homes • Medical Xxxxxx Care Services • Early Intervention Services (note that the PH-MCO must refer for Early Intervention Services any of its Members who are children from birth to age three (3) who are living in residential facilities. “Children living in residential facilities” describes children who are in a 24-hour living setting in which care is provided for one or more children.) • The OBRA waiver, a homeHome-andand Community-community-based waiver program Based Waiver Program for individuals who have a severe developmental physical disability requiring an Intermediate Care Facility/Nursing Facility Residents with Other Related Conditions (ICF/ORC) level of care • Intellectual Disabilities Home-and Community-Based Waiver Program for Nursing Facility Applicants with Other Related Conditions • Home-and Community-Based Waiver for Attendant Care Services (note the PH-MCO is responsible to ensure a family with a child who has or is at risk of a developmental delay is referred to the County Intellectual Disabilities office for a determination of eligibility for home and community-based services, including children living in residential facilities as described above.) • Home-and Community-Based Waiver for Persons with Intellectual Disabilities • COMMCARE Waiver for Persons with a Primary Diagnosis of Acquired Brain Injury • Children in Residential Facilities • Home-and Community-Based Waiver for Persons with Autism The PH-MCO must provide the necessary related services for Members in facilities as described in Exhibit O, Description of Facilities and Related Services. Out-of-Plan Services are described in Exhibit P, Out-of-Plan Services. Recipient coverage rules are outlined in Exhibit BB, PH-MCO Recipient Coverage Document.

Coordination of Care. The PH-MCO must coordinate care for its Members. The PH-MCO must provide for seamless and continuous coordination of care across a continuum of services for the Member with a focus on improving health care outcomes. The continuum of services may include the In-Plan comprehensive service package, out-of-plan services, and non-MA covered services provided by other community resources such as: •  Nursing Facility Care •  Intermediate Care Facility for the Intellectually Disabled/Other Related Conditions •  Residential Treatment Facility •  Acute Psychiatric Facilities •  Extended and Extended Acute Psychiatric Facilities •  Non-Hospital Residential Detoxification, Rehabilitation, and Half- Half-Way House Facilities for Drug/Alcohol Dependence/ Addiction • Opioid Use Disorder Centers of Excellence • Aging Well PA AAA/Level of Care OPTIONS Assessment and Pre-admission Screening Requirements •  PDA Waiver  Juvenile Detention Centers •  Children in Substitute Care Transition •  Adoption Assistance for Children and Adolescents •  Services to Dual Eligibles Under the Age of Twenty-one •  Transitional Care Homes •  Medical Xxxxxx Care Services •  Early Intervention Services (note that the PH-MCO must refer for Early Intervention Services any of its Members who are children from birth to age three (3) who are living in residential facilities. “Children living in residential facilities” describes children who are in a 24-hour living setting in which care is provided for one or more children.) • The OBRA waiver, a home Home-andand Community-community-based waiver program Based Waiver Program for individuals who have a severe developmental physical disability requiring an Intermediate Care Facility/Nursing Facility Residents with Other Related Conditions (ICF/ORC) level of care • Intellectual Disabilities  Home-and Community-Based Waiver Program for Nursing Facility Applicants with Other Related Conditions  Home-and Community-Based Waiver for Attendant Care Services (note the PH-MCO is responsible to ensure a family with a child who has or is at risk of a developmental delay is referred to the County Intellectual Disabilities office for a determination of eligibility for home and community-based services, including children living in residential facilities as described above.) •  Home-and Community-Based Waiver for Persons with Intellectual Disabilities •  COMMCARE Waiver for Persons with a Primary Diagnosis of Acquired Brain Injury  Children in Residential Facilities •  Home-and Community-Based Waiver for Persons with Autism The PH-MCO must provide the necessary related services for Members in facilities as described in Exhibit O, Description of Facilities and Related Services. Out-of-Plan Services are described in Exhibit P, Out-of-Plan Services. Recipient coverage rules are outlined in Exhibit BB, PH-MCO Recipient Coverage Document.

Coordination of Care. ‌ The PH-MCO must coordinate care for its Members. The PH-MCO must provide for seamless and continuous coordination of care across a continuum of services for the Member with a focus on improving health care outcomes. The continuum of services may include the In-Plan comprehensive service package, out-of-plan services, and non-MA covered services provided by other community resources such as: • Nursing Facility Care • Intermediate Care Facility for the Intellectually Disabled/Other Related Conditions • Residential Treatment Facility • Acute Psychiatric Facilities • Extended and Extended Acute Psychiatric Facilities • Non-Hospital Residential Detoxification, Rehabilitation, and Half- Way House Facilities for Drug/Alcohol Dependence/ Addiction • Opioid Use Disorder Centers of Excellence • Aging Well PAAAA/Level of Care Assessment Functional Eligibility Determination and Pre-admission Screening Requirements • PDA Waiver • Juvenile Detention Centers • Children in Substitute Care Transition • Adoption Assistance for Children and Adolescents • Services to Dual Eligibles Under the Age of Twenty-one • Transitional Care Homes • Medical Xxxxxx Care Services • Early Intervention Services (note that the PH-MCO must refer for Early Intervention Services any of its Members who are children from birth to age three (3) who are living in residential facilities. “Children living in residential facilities” describes children who are in a 24-hour living setting in which care is provided for one or more children.) • The OBRA waiver, a homeHome-andand Community-community-based waiver program Based Waiver Program for individuals who have a severe developmental physical disability requiring an Intermediate Care Facility/Nursing Facility Residents with Other Related Conditions (ICF/ORC) level of care • Intellectual Disabilities Home-and Community-Based Waiver Program for Nursing Facility Applicants with Other Related Conditions • Home-and Community-Based Waiver for Attendant Care Services (note the PH-MCO is responsible to ensure a family with a child who has or is at risk of a developmental delay is referred to the County Intellectual Disabilities office for a determination of eligibility for home and community-based services, including children living in residential facilities as described above.) • Home-and Community-Based Waiver for Persons with Intellectual Disabilities • COMMCARE Waiver for Persons with a Primary Diagnosis of Acquired Brain Injury • Children in Residential Facilities • Home-and Community-Based Waiver for Persons with Autism The PH-MCO must provide the necessary related services for Members in facilities as described in Exhibit O, Description of Facilities and Related Services. Out-of-Plan Services are described in Exhibit P, Out-of-Plan Services. Recipient coverage rules are outlined in Exhibit BB, PH-MCO Recipient Coverage Document.

Coordination of Care. ‌ The PH-MCO must coordinate care for its Members. The PH-MCO must provide for seamless and continuous coordination of care across a continuum of services for the Member with a focus on improving health care outcomes. The continuum of services may include the In-Plan comprehensive service package, out-of-plan services, and non-MA covered services provided by other community resources such as: • ● Nursing Facility Care • ● Intermediate Care Facility for the Intellectually Disabled/Other Related Conditions • ● Residential Treatment Facility • ● Acute Psychiatric Facilities • ● Extended and Extended Acute Psychiatric Facilities • ● Non-Hospital Residential Detoxification, Rehabilitation, and Half- Way House Facilities for Drug/Alcohol Dependence/ Addiction • ● Opioid Use Disorder Centers of Excellence • ● Aging Well PA/Level of Care Assessment and Pre-admission Screening Requirements • ● Juvenile Detention Centers • ● Children in Substitute Care Transition • ● Adoption Assistance for Children and Adolescents • ● Services to Dual Eligibles Under the Age of Twenty-one • ● Transitional Care Homes • ● Medical Xxxxxx Care Services • ● Additional Examples given in Exhibit OO ● Early Intervention Services (note the PH-MCO must refer for Early Intervention Services any of its Members who are children from birth to age three (3) who are living in residential facilities. “Children living in residential facilities” describes children who are in a 24-hour living setting in which care is provided for one or more children.) • ● The OBRA waiver, a home-and-community-based waiver program for individuals who have a severe developmental physical disability requiring an Intermediate Care Facility/Other Related Conditions (ICF/ORC) level of care • ● Intellectual Disabilities Services (note the PH-MCO is responsible to ensure a family with a child who has or is at risk of a developmental delay is referred to the County Intellectual Disabilities office for a determination of eligibility for home and community-based services, including children living in residential facilities as described above.) • Home-and Community-Based Waiver for Persons with Intellectual Disabilities • ● Children in Residential Facilities • ● Home-and Community-Based Waiver for Persons with Autism The PH-MCO must provide the necessary related services for Members in facilities as described in Exhibit O, Description of Facilities and Related Services. Out-of-Plan Services are described in Exhibit P, Out-of-Plan Services. Recipient coverage rules are outlined in Exhibit BB, PH-MCO Recipient Coverage Document.

Coordination of Care. ‌ The PH-MCO must coordinate care for its Members. The PH-MCO must provide for seamless and continuous coordination of care across a continuum of services for the Member with a focus on improving health care outcomes. The continuum of services may include the In-Plan comprehensive service package, outOut-of-plan servicesPlan-Services, and non-MA covered services provided by other community resources such as: • ● Nursing Facility Care • ● Intermediate Care Facility for the Intellectually Disabled/Other Related Conditions • ● Residential Treatment Facility • ● Acute Psychiatric Facilities • ● Extended and Extended Acute Psychiatric Facilities • ● Non-Hospital Residential Detoxification, Rehabilitation, and Half- Way House Facilities for Drug/Alcohol Dependence/ Addiction • Substance Use Disorder ● Opioid Use Disorder Centers of Excellence • ● Aging Well PA/Level of Care Assessment and Pre-admission Screening Requirements • ● Juvenile Detention Centers • ● Children in Substitute Care Transition • ● Adoption Assistance for Children and Adolescents • ● Services to Dual Eligibles Under the Age of Twenty-one • ● Transitional Care Homes • ● Medical Xxxxxx Care Services • ● Early Intervention Services (note the PH-MCO must refer for Early Intervention Services any of its Members who are children from birth to age three (3) who are living in residential facilities. “Children living in residential facilities” describes children who are in a 24-hour living setting in which care is provided for one or more children.) • ● The OBRA waiver, a home-and-community-based waiver program for individuals who have a severe developmental physical disability requiring an Intermediate Care Facility/Other Related Conditions (ICF/ORC) level of care • ● Intellectual Disabilities Services (note the PH-MCO is responsible to ensure a family with a child who has or is at risk of a developmental delay is referred to the County Intellectual Disabilities office for a determination of eligibility for home and community-based services, including children living in residential facilities as described above.) • Home-Home and Community-Based Waiver Waivers for Persons with Intellectual Disabilities • or Autism ● Children in Residential Facilities • Home-and Community-Based Waiver for Persons with Autism The PH-MCO must provide the necessary related services for Members in facilities as described in Exhibit O, Description of Facilities and Related Services. Out-of-Plan Services are described in Exhibit P, Out-of-Plan Services. Recipient coverage rules are outlined in Exhibit BB, PH-MCO Recipient Coverage Document. A non-exclusive list of entities that may perform coordination of care activities may be found in Exhibit OO, Coordination of Care Entities.