Common use of Coordination of Care Clause in Contracts

Coordination of Care. (a) The MA Dual SNP is responsible for coordinating the delivery of all benefits covered by both Medicare and Medicaid for Dual Eligible Members, and Other Dual SNP Members who are eligible for LTSS, including when benefits are delivered via Medicaid fee-for-service. The MA Dual SNP must make reasonable efforts to coordinate Medicare Advantage benefits provided by the MA Dual SNP with LTSS provided through Texas Health and Human Services Commission and the STAR+PLUS MCOs. Coordination of Care must include the following for these members: (1) identify providers of covered Medicaid LTSS in the Texas service areas identified in Attachment C, Proposed MA Product Service Areas; (2) help access needed Medicaid LTSS, to the extent they are available to the member; (3) help coordinate the delivery of Medicaid LTSS and Medicare benefits and services; and (4) provide training to its Network Providers regarding Medicaid LTSS so that they may help members receive needed LTSS that are not covered by Medicare. The MA Dual SNP must inform Network Providers of the Medicare benefits and Medicaid LTSS available to Dual Eligible Members and Other Dual SNP Members. rdination of Care efforts for LTSS may include protocols for working with STAR+PLUS service coordinators or HHSC caseworkers, as well as protocols for reciprocal referral and communication of data and clinical information regarding Dual Eligible Members with the coordinators and caseworkers.

Coordination of Care. (a) The MA Dual SNP is responsible for coordinating the delivery of all benefits covered by both Medicare and Medicaid for Dual Eligible Members, and Other Dual SNP Members who are eligible for LTSS, including when benefits are delivered via Medicaid fee-for-service. The MA Dual SNP must make reasonable efforts to coordinate Medicare Advantage benefits provided by the MA Dual SNP with LTSS provided through Texas Health and Human Services Commission and the STAR+PLUS MCOs. Coordination of Care must include the following for these members: (1) identify providers of covered Medicaid LTSS in the Texas service areas identified in Attachment C, Proposed MA Product Service Areas; (2) help access needed Medicaid LTSS, to the extent they are available to the member; (3) help coordinate the delivery of Medicaid LTSS and Medicare benefits and services; and (4) provide training to its Network Providers regarding Medicaid LTSS so that they may help members receive needed LTSS that are not covered by Medicare. The MA Dual SNP must inform Network Providers of the Medicare benefits and Medicaid LTSS available to Dual Eligible Members and Other Dual SNP Members. rdination of Care efforts for LTSS may include protocols for working with STAR+PLUS service coordinators or HHSC caseworkers, as well as protocols for reciprocal referral and communication of data and clinical information regarding Dual Eligible Members with the coordinators and caseworkers.

Coordination of Care. (a) The MA Dual SNP is responsible for coordinating the delivery of all benefits covered by both Medicare and Medicaid for Dual Eligible Members, and Other Dual SNP Members who are eligible for LTSS, including when benefits are delivered via Medicaid fee-for-service. The MA Dual SNP must make reasonable efforts to coordinate Medicare Advantage benefits provided by the MA Dual SNP with LTSS provided through Texas Health and Human Services Commission and the STAR+PLUS MCOs. Coordination of Care must include the following for these members: (1) identify providers of covered Medicaid LTSS in the Texas service areas identified in Attachment C, Proposed MA Product Service Areas; (2) help access needed Medicaid LTSS, to the extent they are available to the member; (3) help coordinate the delivery of Medicaid LTSS and Medicare benefits and services; and (4) provide training to its Network Providers regarding Medicaid LTSS so that they may help members receive needed LTSS that are not covered by Medicare. The MA Dual SNP must inform Network Providers of the Medicare benefits and Medicaid LTSS available to Dual Eligible Members and Other Dual SNP Members. rdination of Care efforts for LTSS may include protocols for working with STAR+PLUS service coordinators or HHSC caseworkers, as well as protocols for reciprocal referral and communication of data and clinical information regarding Dual Eligible Members with the coordinators and caseworkers.