Common use of Establishment of Special Needs Unit Clause in Contracts

Establishment of Special Needs Unit. a. The PH-MCO must develop, train, and maintain a unit within its organizational structure to deal with issues relating to Members with Special Needs ("Special Needs Unit” [SNU]). The purpose of the SNU is to ensure that each Member with Special Needs receives access to PCPs, dentists, and specialists trained and skilled in the Special Needs of the Member; information about and access to a specialist, as appropriate; information about and access to all covered services appropriate to the Member's condition or circumstance, including Pharmacy, Durable Medical Equipment (DME); access to LEP and sign language interpreter services, LEP translation services and access to needed community services. The PH-MCO must show evidence they can execute agreements with individuals who have expertise in the treatment of Special Needs to provide consultation to the SNU staff, as needed. b. The PH-MCO agrees to comply with the Department's requirements and determination of whether a Member shall be classified as having a Special Need, which determination must be based on criteria set forth in Exhibit NN of this Agreement, Special Needs Unit. c. It is the responsibility of the SNU to arrange for and ensure coordination between the PH-MCO and other health, education, and human service systems for Members with Special Needs. See Exhibit OO of this Agreement, Coordination of Care Entities, for an example but not an all- inclusive list. The PH-MCO is responsible to coordinate the comprehensive in-plan package of services with entities providing Out-of-Plan Services. d. The PH-MCO must assure that outpatient case management services for Members under age twenty-one (21) are not provided through any individual employed by the PH-MCO or through a subcontractor of the PH-MCO if the individual's responsibilities include outpatient utilization review or otherwise include reviews of requests for authorization of outpatient benefits. In addition, if the PH-MCO provides Case Management Services to Members under the age of twenty-one (21) through the SNU, the PH-MCO must assure that the SNU assists individuals in gaining access to necessary medical, social, education, and other services in accordance with MA Bulletin #1239-94-01 Medical Assistance Case Management Services for Recipients Under the Age of 21. e. The PH-MCO must comply with SNU reporting requirements as specified by the Department and described in Exhibit NN of this Agreement, Special Needs Unit.

Establishment of Special Needs Unit. a. The PH-MCO must develop, train, and maintain a unit SNU within its organizational structure to deal with issues relating to Members with Special Needs ("Special Needs Unit” [SNU])Needs. The purpose of the SNU is to ensure that all Members with special needs are able to receive all necessary services and supports in a timely manner. The SNU must also assist each Member member with Special Needs receives a special need with access to PCPs, dentists, services and specialists trained and skilled in the Special Needs of the Member; information about and access relevant to a specialist, as appropriate; information about and access to all covered services appropriate to the Member's their special condition or circumstance, including Pharmacy, Durable Medical Equipment (DME); access . The SNU must proactively identify and outreach to LEP and sign language interpreter services, LEP translation members with special needs to provide these services and access information. These services will include all those needed by a member with special needs to needed community servicesaddress their condition or circumstance and will include but not be limited to all functions and requirements as stated in Exhibit NN, Special Needs Unit. The PH-MCO must show evidence they can employ or execute agreements with individuals who have expertise experts in the treatment of Special Needs to provide consultation to the SNU staff, staff as needed. b. The PH-MCO agrees to must comply with the Department's non- categorical definition as determined by the requirements and determination of whether a Member shall be classified as having a Special Need, which determination must be based on criteria set forth outlined in Exhibit NN of this AgreementNN, Special Needs Unit. c. It is the responsibility of the The SNU to must arrange for and ensure provide coordination between the PH-MCO MCO, the BH-MCOs and other health, education, and human service systems for Members with Special Needs. See Exhibit OO of this AgreementOO, Coordination of Care Entities, for an example but not an all- inclusive list. The PH-MCO is responsible to must coordinate the comprehensive in-plan package of services with entities providing Out-of-Plan Services. d. The PH-MCO must assure require that outpatient case management services for Members under age twenty-one (21) are not provided through any individual employed by the PH-MCO or through a subcontractor of the PH-PH- MCO if the individual's responsibilities include outpatient utilization review or otherwise include reviews of requests for authorization of outpatient benefits. In addition, if . e. If the PH-MCO provides Case Management Services to Members under the age of twenty-one (21) through the SNU, the PH-MCO must assure requrie that the SNU assists individuals in gaining access to necessary medical, social, education, and other services in accordance with MA Bulletin #1239-94-01 Medical Assistance Case Management Services for Recipients Under the Age of 21. e. The PH-MCO must comply with SNU reporting requirements f. In addition to other telephone and alternative communication channels, it is required that a dedicated Special Needs hotline be established and maintained as specified by a toll free direct dial access to the Department and described in Exhibit NN of this Agreement, Special Needs Unit. This hotline shall be staffed by Special Needs Staff members during normal business hours, Monday through Friday and in sufficient numbers that calls are answered in a timely manner, with no longer than a one minute wait time, or provision made to call the member back within one hour following the initial call.

Establishment of Special Needs Unit. ‌ a. The PH-MCO must develop, train, and maintain a unit SNU within its organizational structure to deal with issues relating to Members with Special Needs ("Special Needs Unit” [SNU])Needs. The purpose of the SNU is to ensure that all Members with special needs are able to receive all necessary services and supports in a timely manner. The SNU must also assist each Member member with Special Needs receives a special need with access to PCPs, dentists, services and specialists trained and skilled in the Special Needs of the Member; information about and access relevant to a specialist, as appropriate; information about and access to all covered services appropriate to the Member's their special condition or circumstance, including Pharmacy, Durable Medical Equipment (DME); access . The SNU must proactively identify and outreach to LEP and sign language interpreter services, LEP translation members with special needs to provide these services and access information. These services will include all those needed by a member with special needs to needed community servicesaddress their condition or circumstance and will include but not be limited to all functions and requirements as stated in Exhibit NN, Special Needs Unit. The PH-MCO must show evidence they can employ or execute agreements with individuals who have expertise experts in the treatment of Special Needs to provide consultation to the SNU staff, staff as needed. b. The PH-MCO agrees to must comply with the Department's non-categorical definition as determined by the requirements and determination of whether a Member shall be classified as having a Special Need, which determination must be based on criteria set forth outlined in Exhibit NN of this AgreementNN, Special Needs Unit. c. It is the responsibility of the The SNU to must arrange for and ensure provide coordination between the PH-MCO MCO, the BH-MCOs and other health, education, and human service systems for Members with Special Needs. See Exhibit OO of this AgreementOO, Coordination of Care Entities, for an example but not an all- inclusive list. The PH-MCO is responsible to must coordinate the comprehensive in-plan package of services with entities providing Out-of-Plan Services. d. The PH-MCO must assure require that outpatient case management services for Members under age twenty-one (21) are not provided through any individual employed by the PH-MCO or through a subcontractor Subcontractor of the PH-PH­ MCO if the individual's responsibilities include outpatient utilization review or otherwise include reviews of requests for authorization of outpatient benefits. In addition, if . e. If the PH-MCO provides Case Management Services to Members under the age of twenty-one (21) through the SNU, the PH-MCO must assure require that the SNU assists individuals in gaining access to necessary medical, social, education, and other services in accordance with MA Bulletin #1239-94-01 Medical Assistance Case Management Services for Recipients Under the Age of 21. e. f. In addition to other telephone and alternative communication channels, it is required that a dedicated Special Needs hotline be established and maintained as a toll free direct dial access to the Special Needs Unit. This hotline shall be staffed by Special Needs Staff members during normal business hours, Monday through Friday and in sufficient numbers that calls are answered in a timely manner, with no longer than a one minute wait time, or provision made to call the member back within one hour following the initial call. g. The PH-MCO SNU must comply assess and assist members with SNU reporting requirements as specified by the Department social factors that affect health outcomes. Social determinants of health include, but are not limited to, housing, food insecurity, health literacy, access to transportation, education, and described in Exhibit NN of this Agreement, Special Needs Unitemployment.

Establishment of Special Needs Unit. ‌ a. The PH-MCO must develop, train, and maintain a unit SNU within its organizational structure to deal with issues relating to Members with Special Needs ("Special Needs Unit” [SNU])Needs. The purpose of the SNU is to ensure that all Members with special needs are able to receive all necessary services and supports in a timely manner. The SNU must also assist each Member member with Special Needs receives a special need with access to PCPs, dentists, services and specialists trained and skilled in the Special Needs of the Member; information about and access relevant to a specialist, as appropriate; information about and access to all covered services appropriate to the Member's their special condition or circumstance, including Pharmacy, Durable Medical Equipment (DME); access . The SNU must proactively identify and outreach to LEP and sign language interpreter services, LEP translation members with special needs to provide these services and access information. These services will include all those needed by a member with special needs to needed community servicesaddress their condition or circumstance and will include but not be limited to all functions and requirements as stated in Exhibit NN, Special Needs Unit. The PH-MCO must show evidence they can employ or execute agreements with individuals who have expertise experts in the treatment of Special Needs to provide consultation to the SNU staff, staff as needed. b. The PH-MCO agrees to must comply with the Department's non- categorical definition as determined by the requirements and determination of whether a Member shall be classified as having a Special Need, which determination must be based on criteria set forth outlined in Exhibit NN of this AgreementNN, Special Needs Unit. c. It is the responsibility of the The SNU to must arrange for and ensure provide coordination between the PH-MCO MCO, the BH-MCOs and other health, education, and human service systems for Members with Special Needs. See Exhibit OO of this AgreementOO, Coordination of Care Entities, for an example but not an all- inclusive list. The PH-MCO is responsible to must coordinate the comprehensive in-plan package of services with entities providing Out-of-Plan Services. d. The PH-MCO must assure require that outpatient case management services for Members under age twenty-one (21) are not provided through any individual employed by the PH-MCO or through a subcontractor of the PH-PH- MCO if the individual's responsibilities include outpatient utilization review or otherwise include reviews of requests for authorization of outpatient benefits. In addition, if . e. If the PH-MCO provides Case Management Services to Members under the age of twenty-one (21) through the SNU, the PH-MCO must assure requrie that the SNU assists individuals in gaining access to necessary medical, social, education, and other services in accordance with MA Bulletin #1239-94-01 Medical Assistance Case Management Services for Recipients Under the Age of 21. e. The PH-MCO must comply with SNU reporting requirements as specified by the Department and described in Exhibit NN of this Agreement, Special Needs Unit.