Covered Service Components. Without limiting the generality of Contractor’s obligation to provide integrated care and coordination for Covered Services, the following responsibilities are required by law, and must be implemented in conjunction with its integrated care and coordination responsibilities stated above.
Covered Service Components. Other Services
a. Care Coordination
(1) Contractor shall provide Care Coordination to all members consistent with OARs 410- 141-3860, 410-141-3865, and 410-141-3870 and 42 CFR § 438.208.
(2) Contractor shall maintain Care Coordination (CC) policies and procedures that comply with OARs 410-141-3860, 410-141-3865, and 410-141-3870. Contractor shall submit its CC policies and procedures to OHA, via Administrative Notice, for review and approval as follows: (i) by January 31 of each Contract Year; (ii) upon any material change to such policies and procedures; and (iii) within five Business Days of request, as made by OHA from time to time. Contractor shall not implement changes in its CC policies and procedures until approved in writing by OHA. If no changes have been made to Contractor’s CC policies and procedures since last approved by OHA, Contractor may, for its annual January 31 submission, submit to OHA via Administrative Notice, an Attestation stating that no changes have been made. OHA will notify Contractor within thirty (30) days from the due date, or within thirty (30) days from the received date if after the due date, of the approval status of its CC policies and procedures; OHA will notify Contractor within the same period if additional time is needed for review. In the event OHA determines Contractor’s CC policies and procedures do not comply with the criteria set forth herein, Contractor shall follow the process set forth in Sec. 5 of Ex. D.
(3) Contractor shall submit to OHA, via Administrative Notice, a bi-annual report on its Care Coordination activities no later than forty-five (45) days following the end of each six- month period. The report shall demonstrate Contractor’s ability to fulfill the Care Coordination activities and requirements outlined in OARs 410-141-3860, 410-141-3865, and 410-141-3870. Contractor shall use the reporting template provided by OHA on the CCO Contract Forms Website.
Covered Service Components. Other Services
Covered Service Components. Other Services
a. Intensive Care Coordination
(1) In addition to providing general Coordinated Care Services, Contractor is responsible for assessing, making available, and providing Intensive Care Coordination services in accordance with the requirements set forth in (i) OAR 410-141-3870, (ii) this Para. a., Sec. 8, Ex. B, Part 2, (iii) Sec. 10, Para. b, Ex. B, Part 4, Exhibit M, and (iv) as may be provided for elsewhere in this Contract. Without limiting the foregoing, Contractor shall:
(a) Without requiring a referral, automatically assess all Members of Prioritized Populations for ICC services. Contractor shall make Trauma Informed, Culturally and Linguistically Appropriate ICC services available to all Members of Prioritized Populations who qualify, as a result of such assessment, for such services.
(b) Provide Trauma Informed, Culturally and Linguistically Appropriate ICC services and Behavioral Health Services to children and adolescent Members according to presenting needs.
(c) Provide Trauma Informed, Culturally and Linguistically Appropriate ICC services to Members receiving Medicaid-Funded Long Term Services and Supports including those receiving services in home or community based settings under the State’s 1915(i) or 1915(k) State Plan Amendments or the 1915(c) HCBS Waiver or those in Long Term Care settings.
(d) Assess all Members not identified in SubParas (a)-(c) above of this SubPara (1), Para. a, Sec. 8, Ex. B, Part 2, for ICC services when referred by any of the referrers listed below and make Trauma Informed, Culturally and Linguistically Appropriate ICC services available to all referred Members who qualify for such services as a result of the screening.
i. The Member themselves,
ii. The Member’s Representative, iii. A Provider, including, without limitation, an HCBS Provider or other LTSS Provider, and
Covered Service Components. Other Services
a. Intensive Care Coordination
(1) Making available Trauma Informed, Culturally and Linguistically Appropriate Intensive Care Coordination Services, without the requirement of an assessment, to Members who are expressly identified in OAR 410-141-3170(2)(a)-(o) and those identified in Exhibit B, Part 4, Sec. 10, Para. a, Sub. Para. (1)(a) of this Contract.
(2) Providing Trauma Informed, Culturally and Linguistically Appropriate Intensive Care Coordination Services and Behavioral Health Services to children and adolescent Members according to presenting needs.
(3) Providing Trauma Informed, Culturally and Linguistically Appropriate Intensive Care Coordination Services to Members receiving Medicaid funded home or Community Based Settings for Long Term Care Services and Supports under the State’s 1915(i) or 1915(k) State Plan Amendments or the 1915(c) HCBS Waiver.
(4) Offering Trauma Informed, Culturally and Linguistically Appropriate Intensive Care Coordination Services if qualified by an assessment.
(5) Responding to requests for Intensive Care Coordination services with an initial response by the next Business Day following the request.
(6) Periodically informing all Participating Providers of the availability of Intensive Care Coordination services, providing training to PCPCHs and other PCPs staff regarding the Intensive Care Coordination services and other support services available to Members.
(7) Ensuring that a Member’s DHS Area Agency on Aging/Aging and People with Disabilities, Office of Developmental Disability Services, Long Term Care, or Long Term Services and Supports case manager, have a direct method to contact the Member’s ICC Care Coordination team.
(8) Ensuring that the Member’s case manager’s name and telephone number are available to agency staff and Members or Member Representatives when Intensive Care Coordination services are provided to the Member.
(9) Making Intensive Care Coordination services available to Members who exhibit inappropriate, disruptive, or threatening behaviors in a Practitioner's office or clinic or other health care setting.
(10) Providing prioritized Intensive Care Coordination services to Members who are children and adolescents in the custody of DHS as provided for in Ex. B, Part 4, Sec. 10, Para. a., Sub. Para. (1)(a) of this Contract.
(11) Additional Intensive Care Coordination responsibilities are set forth Sec. 10, para. a, of Ex. B, Part 4, and Exhibit M of this Contract.
Covered Service Components. Other Services
a. Intensive Care Coordination24
(1) In addition to providing general Coordinated Care Services, Contractor is responsible for assessing, making available, and providing Intensive Care Coordination services in accordance with the requirements set forth in (i) OAR 410-141-3870; (ii) this Para. a., Sec. 8, Ex. B, Part 2; (iii) Sec. 9, Para. b, Ex. B, Part 4; (iv)
Covered Service Components. Other Services a.
(1) Contractor shall provide Care Coordination to all members consistent with OARs 410- 141-3860, 410-141-3865, and 410-141-3870 and 42 CFR § 000.000.Xx addition to
Covered Service Components. Exhibit B, Part 2, Section 6 of the Core Contract shall be Delegated to RAE.
