Delivery of Covered Services. Covered Services will be delivered by teams (composed of physician assistants, nurses, nurse practitioners health coaches and medical assistants) led and overseen by a physician (collectively, “Provider(s)”). Health coaches may do the following: (a) conduct intake visits and work with physicians to create care plans; (b) provide education and coaching to patients both individually and in groups; (c) be accessible to patients by phone and email, with coverage arrangements for nights, weekends and holidays; (d) track the progress of patients in meeting their goals; and (e) proactively reach out to patients as needed.
Delivery of Covered Services. (a) Provider/Patient Relationship. Provider shall observe, protect and promote the rights of Members as patients. Nothing contained in this Agreement shall be construed to limit or otherwise restrict Provider’s ethical and legal responsibility to fully advise Members about their medical condition and about medically appropriate treatment options.
Delivery of Covered Services. 4.1(a) Beginning on the Effective Date, PA HRM shall assume the full risk and financial responsibility for the medical claim costs associated with the provision of all Covered Services pursuant to this Agreement.
Delivery of Covered Services. Beginning no sooner than July 1, 2017, HCA shall provide Drug Medi-Cal Organized Delivery System (DMC-ODS) substance use disorder (SUD) services in accordance with the intergovernmental contract between the State Department of Health Care Services and the County of Orange. HCA has agreed to: Amendment I to the MOU for the Coordination of Mental Health Services_Medi-Cal • Maintain a provider network of County and contracted programs sufficient to meet the needs of the Members, with acknowledgement that the following services are benefits outside of DMC-ODS: o medically monitored intensive inpatient services are the responsibility of HCA; o medically managed intensive inpatient services in an acute care hospital, for which CalOptima would provide referral coordination and care, are the responsibility of CalOptima; and o voluntary inpatient detoxification (VID) services in an acute care hospital are Medi-Cal fee for service benefits. • Continually monitor and provide oversight to the DMC provider network to ensure Member access to quality SUD care. HCA will ensure the delivery of SUD services are within the scope of the SUD providers’ scope of practice.
