Family Planning Provider Network. The Contractor cannot restrict the choice of the provider from whom the Enrollee may receive family planning services and supplies. The Contractor must provide or arrange family planning services as follows: Ensure that all Enrollees are made aware that family planning services are available to the Enrollee through any MassHealth family planning provider, and that all Enrollees do not need authorization in order to receive such services; Provide all Enrollees with sufficient information and assistance on the process and available providers for accessing family planning services in and out of the One Care Plan network; Provide all Enrollees who seek family planning services from the Contractor with services including, but not limited to: All methods of contraception, including sterilization, vasectomy, and emergency contraception; Counseling regarding HIV, sexually transmitted diseases, and risk reduction practices; and Options counseling for pregnant Enrollees, including referrals for the following: prenatal care, xxxxxx care or adoption, or pregnancy termination; and Comply with the requirements of 42 C.F.R. § 441.202 and the Abortion Services Contract between EOHHS and the Contractor. Behavioral Health Network Requirements Substance Use Disorder Treatment Providers To the extent permitted by law, the Contractor shall require all substance use disorder treatment providers to submit to DPH/BSAS the data required by DPH. The Contractor shall require all substance use disorder treatment providers to track, by referral source: All referrals for services;
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Samples: www.mass.gov, www.mass.gov, www.mass.gov
Family Planning Provider Network. The Contractor cannot restrict the choice of the provider from whom the Enrollee may receive family planning services and supplies. The Contractor must provide or arrange family planning services as follows: Ensure that all Enrollees are made aware that family planning services are available to the Enrollee through any MassHealth family planning provider, and that all Enrollees do not need authorization in order to receive such services; Provide all Enrollees with sufficient information and assistance on the process and available providers for accessing family planning services in and out of the One Care Plan network; Provide all Enrollees who seek family planning services from the Contractor with services including, but not limited to: All methods of contraception, including sterilization, vasectomy, and emergency contraception; Counseling regarding HIV, sexually transmitted diseases, and risk reduction practices; and Options counseling for pregnant Enrollees, including referrals for the following: prenatal care, xxxxxx care or adoption, or pregnancy termination; and Comply with the requirements of 42 C.F.R. § 441.202 and the Abortion Services Contract between EOHHS and the Contractor. Behavioral Health Network Requirements Substance Use Disorder Treatment Providers To the extent permitted by law, the Contractor shall require all substance use disorder treatment providers to submit to DPH/BSAS the data required by DPH. The Contractor shall require all substance use disorder treatment providers to track, by referral source: All referrals for services;; The outcome of each referral (i.e., admission, etc.); and If the substance use disorder treatment provider refuses to accept a referral, the reason for the refusal. The Contractor shall, unless otherwise directed by EOHHS, work collaboratively with EOHHS and with MassHealth‑contracted plans to implement a unified Network Management strategy for managing the ASAM Level 3.1 Residential Rehabilitation Services for Substance Use Disorders network, including Enhanced Residential Rehabilitation Services (“the RRS network”). The Contractor shall: As further directed by EOHHS and in accordance with all other applicable Contract requirements, contract with all willing, qualified, and licensed RRS providers; The Contractor shall support each RRS provider’s efforts to establish and sustain collaborative partnerships among service providers and community stakeholders in its geographic area; Ensure that RRS is provided in accordance with EOHHS‑ approved RRS performance specifications and RRS Medical Necessity Criteria which shall align with the American Society For Addiction Medicine (ASAM) criteria; Submit for EOHHS’s approval authorization and concurrent review procedures for RRS, and any changes to such authorization and concurrent review procedures prior to their implementation. The Contractor shall: Utilize the American Society for Addiction Medicine (ASAM) criteria as the basis for establishing authorization and concurrent review procedures; Assist RRS Providers in learning how to utilize the Contractor’s authorization and concurrent review procedures with respect to RRS; Ensure that the authorization procedures established for RRS allow for at least the first ninety (90) days to occur without prior approval, provided however that the Contractor may establish notification or registration procedures during the first ninety (90) days of RRS; and Assign a single point of contact for management of the RRS network. The Contractor’s single point of contact’s responsibilities shall include, but not be limited to, providing in‑ person technical assistance to RRS Providers to answer questions regarding billing and authorization of services and assisting RRS Providers in facilitating and ensuring that Enrollees are connected to other services as indicated by the Enrollees treatment plan; The Contractor shall, unless otherwise directed by EOHHS, work collaboratively with EOHHS and with MassHealth‑contracted plans to implement a unified Network Management strategy for managing Recovery Coach services. The Contractor shall: As directed by EOHHS and in accordance with all other applicable Contract requirements, contract with all licensed behavioral health outpatient and licensed opioid treatment programs that offer Recovery Coach services in the One Care Plan’s Service Area; Ensure that Recovery Coach services are provided in accordance with all EOHHS approved Recovery Coach performance specifications and Recovery Coach Medical Necessity Criteria; and Submit for EOHHS’ approval authorization and concurrent review procedures for Recovery Coach services, and any changes to such authorization and concurrent review procedures prior to their implementation. The Contractor shall: Assist Providers in learning how to utilize the Contractor’s authorization and concurrent review procedures with respect to Recovery Coach services; and Ensure that the authorization procedures established for Recovery Coach services allow for at least the first one hundred and eighty (180) days to occur without prior approval, provided however that the Contractor may establish notification or registration procedures during the first one hundred and eighty (180) days of Recovery Coach services; The Contractor shall, unless otherwise directed by EOHHS, work collaboratively with EOHHS and with MassHealth‑contracted plans to implement a unified Network Management strategy for managing the Recovery Support Navigator network. The Contractor shall: As directed by EOHHS and in accordance with all other applicable Contract requirements, contract with all licensed behavioral health outpatient and licensed opioid treatment programs that offer Recovery Support Navigator services in the One Care Plan’s Service Area; Ensure that Recovery Support Navigator services are provided in accordance with all EOHHS approved Recovery Support Navigator performance specifications and Recovery Support Navigator Medical Necessity Criteria; Submit for EOHHS’s approval authorization and concurrent review procedures for Recovery Support Navigator services, and any changes to such authorization and concurrent review procedures prior to their implementation. The Contractor shall: Assist Providers in learning how to utilize the Contractor’s authorization and concurrent review procedures with respect to Recovery Support Navigator services; and Ensure that the authorization procedures established for Recovery Support Navigator allow for at least the first ninety (90) days to occur without prior approval, provided however that the Contractor may establish notification or registration procedures during the first ninety (90) days of Recovery Support Navigator services. State‑Operated Community Mental Health Centers (SOCMHCs) The Contractor shall refer cases to the SOCMHCs in a manner that is consistent with the policies and procedures for network referrals generally. Emergency Services Programs (ESPs) The Contractor must maintain relationships execute and maintain contracts with the Emergency Services Program (ESP) providers that are located within the Contractor’s Service Area to provide ESP services. The Contractor must execute and maintain contracts with ESPs that are not run by the Department of Mental Health. If the Contractor does not contract with ESPs operated by DMH, the Contractor shall coordinate admissions and triage with DMH ESPs as it would with any contracted ESP. The Contractor must include the ESPs serving members in each county where the Contractor operates in its Behavioral Health Provider Network as part of the Covered Services for Behavioral health as referenced in Appendix A and defined in Appendix B. The Contractor will contract with the ESPs according to the established Performance Specifications that currently exist for MassHealth‑only members. The Contractor must contract with hospitals operated by the DMH and the DPH.
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Samples: www.mass.gov
Family Planning Provider Network. The Contractor cannot restrict the choice of the provider from whom the Enrollee may receive family planning services and supplies. The Contractor must provide or arrange family planning services as follows: Ensure that all Enrollees are made aware that family planning services are available to the Enrollee through any MassHealth family planning provider, and that all Enrollees do not need authorization in order to receive such services; Provide all Enrollees with sufficient information and assistance on the process and available providers for accessing family planning services in and out of the One Care Plan network; Provide all Enrollees who seek family planning services from the Contractor with services including, but not limited to: All methods of contraception, including sterilization, vasectomy, and emergency contraception; Counseling regarding HIV, sexually transmitted diseases, and risk reduction practices; and Options counseling for pregnant Enrollees, including referrals for the following: prenatal care, xxxxxx care or adoption, or pregnancy termination; and Comply with the requirements of 42 C.F.R. § 441.202 and the Abortion Services Contract between EOHHS and the Contractor. Behavioral Health Network Requirements Substance Use Disorder Treatment Providers To the extent permitted by law, the Contractor shall require all substance use disorder treatment providers to submit to DPH/BSAS the data required by DPH. The Contractor shall require all substance use disorder treatment providers to track, by referral source: All referrals for services;; The outcome of each referral (i.e., admission, etc.); and If the substance use disorder treatment provider refuses to accept a referral, the reason for the refusal. The Contractor shall, unless otherwise directed by EOHHS, work collaboratively with EOHHS and with MassHealth-contracted plans to implement a unified Network Management strategy for managing the ASAM Level 3.1 Residential Rehabilitation Services for Substance Use Disorders network, including Enhanced Residential Rehabilitation Services (“the RRS network”). The Contractor shall: As further directed by EOHHS and in accordance with all other applicable Contract requirements, contract with all willing, qualified, and licensed RRS providers; The Contractor shall support each RRS provider’s efforts to establish and sustain collaborative partnerships among service providers and community stakeholders in its geographic area; Ensure that RRS is provided in accordance with EOHHS- approved RRS performance specifications and RRS Medical Necessity Criteria which shall align with the American Society For Addiction Medicine (ASAM) criteria; Submit for EOHHS’s approval authorization and concurrent review procedures for RRS, and any changes to such authorization and concurrent review procedures prior to their implementation. The Contractor shall: Utilize the American Society for Addiction Medicine (ASAM) criteria as the basis for establishing authorization and concurrent review procedures; Assist RRS Providers in learning how to utilize the Contractor’s authorization and concurrent review procedures with respect to RRS; Ensure that the authorization procedures established for RRS allow for at least the first ninety (90) days to occur without prior approval, provided however that the Contractor may establish notification or registration procedures during the first ninety (90) days of RRS; and Assign a single point of contact for management of the RRS network. The Contractor’s single point of contact’s responsibilities shall include, but not be limited to, providing in- person technical assistance to RRS Providers to answer questions regarding billing and authorization of services and assisting RRS Providers in facilitating and ensuring that Enrollees are connected to other services as indicated by the Enrollees treatment plan; The Contractor shall, unless otherwise directed by EOHHS, work collaboratively with EOHHS and with MassHealth-contracted plans to implement a unified Network Management strategy for managing Recovery Coach services. The Contractor shall: As directed by EOHHS and in accordance with all other applicable Contract requirements, contract with all licensed behavioral health outpatient and licensed opioid treatment programs that offer Recovery Coach services in the One Care Plan’s Service Area; Ensure that Recovery Coach services are provided in accordance with all EOHHS approved Recovery Coach performance specifications and Recovery Coach Medical Necessity Criteria; and Submit for EOHHS’ approval authorization and concurrent review procedures for Recovery Coach services, and any changes to such authorization and concurrent review procedures prior to their implementation. The Contractor shall: Assist Providers in learning how to utilize the Contractor’s authorization and concurrent review procedures with respect to Recovery Coach services; and Ensure that the authorization procedures established for Recovery Coach services allow for at least the first one hundred and eighty (180) days to occur without prior approval, provided however that the Contractor may establish notification or registration procedures during the first one hundred and eighty (180) days of Recovery Coach services; The Contractor shall, unless otherwise directed by EOHHS, work collaboratively with EOHHS and with MassHealth-contracted plans to implement a unified Network Management strategy for managing the Recovery Support Navigator network. The Contractor shall: As directed by EOHHS and in accordance with all other applicable Contract requirements, contract with all licensed behavioral health outpatient and licensed opioid treatment programs that offer Recovery Support Navigator services in the One Care Plan’s Service Area; Ensure that Recovery Support Navigator services are provided in accordance with all EOHHS approved Recovery Support Navigator performance specifications and Recovery Support Navigator Medical Necessity Criteria; Submit for EOHHS’s approval authorization and concurrent review procedures for Recovery Support Navigator services, and any changes to such authorization and concurrent review procedures prior to their implementation. The Contractor shall: Assist Providers in learning how to utilize the Contractor’s authorization and concurrent review procedures with respect to Recovery Support Navigator services; and Ensure that the authorization procedures established for Recovery Support Navigator allow for at least the first ninety (90) days to occur without prior approval, provided however that the Contractor may establish notification or registration procedures during the first ninety (90) days of Recovery Support Navigator services. State-Operated Community Mental Health Centers (SOCMHCs) The Contractor shall refer cases to the SOCMHCs in a manner that is consistent with the policies and procedures for network referrals generally. Emergency Services Programs (ESPs) The Contractor must maintain relationships execute and maintain contracts with the Emergency Services Program (ESP) providers that are located within the Contractor’s Service Area to provide ESP services. The Contractor must execute and maintain contracts with ESPs that are not run by the Department of Mental Health. If the Contractor does not contract with ESPs operated by DMH, the Contractor shall coordinate admissions and triage with DMH ESPs as it would with any contracted ESP. The Contractor must include the ESPs serving members in each county where the Contractor operates in its Behavioral Health Provider Network as part of the Covered Services for Behavioral health as referenced in Appendix A and defined in Appendix B. The Contractor will contract with the ESPs according to the established Performance Specifications that currently exist for MassHealth-only members. The Contractor must contract with hospitals operated by the DMH and the DPH. Long-Term Services and Supports Provider Network The Contractor’s Provider Network must offer a selection of nursing facility and community LTSS providers that meets Enrollee needs and preferences and satisfies the time and distance requirements at Section 2.8 above.
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Samples: www.mass.gov
