Common use of Family Planning Clause in Contracts

Family Planning. The Orange County Health Care Agency is a FamilyPACT provider of family planning and pregnancy testing services. Services are provided in accordance with regulations specified by State Office of Family Planning (OFP) and Title X regulations and guidelines. The Standards of Care, promulgated by the State in cooperation with the American College of Obstetricians and Gynecologists (ACOG) and Title X, are the required level of care for all family planning providers and are used as a basis for evaluation of services. Eligibility/ Client Services County/Family Planning will provide family planning services to FamilyPACT eligible CalOptima Direct or CalOptima Health Network members choosing to seek such services outside of their Health Network or CalOptima. CalOptima recognizes that CalOptima Direct or CalOptima Health Network members have the right to choose to seek their family planning services outside of the Health Network/CalOptima. Upon request, CalOptima will provide Health Networks and providers information about low cost/free family planning services for members who lose eligibility. CalOptima, its Health Networks and providers will not require prior authorization for in-network or out- of-network family planning services. CalOptima, its Health Networks and providers will not require parental consent for family planning services for a member under 21 years. QUALITY ASSURANCE: CalOptima will respond to issues of Health Networks inappropriately requesting prior authorization for family planning services, and will take necessary corrective action. Follow-Up Services CalOptima beneficiaries receiving family planning services at County Family Planning clinics who require follow-up of complications associated with contraceptive methods either beyond the scope of practice of County Family Planning clinics or not covered by the DHS definition of family CalOptima Health Networks and Providers will provide family planning services and/or care of complications associated with contraceptive methods either beyond the scope of practice of County Family Planning clinics or not CATEGORY County Family Planning Clinic CalOptima/Health Networks planning services will be referred to their CalOptima Health Network provider for continuing care. covered by the DHS definition of family planning services to CalOptima members referred by County Family Planning clinics. Provider Network Education County Health Referral Line will provide CalOptima members upon request with community and public family planning resources, as well as, providers who are able to provide special linguistic and/or culturally competent services. CalOptima is responsible to ensure that Health Networks and providers are aware that CalOptima members have freedom of choice of family planning services and providers, including out of network providers, without prior authorization. State and Federal regulations mandate the County/MCH Program to promote comprehensive women's and children's health services to meet community needs within the County. Responsibilities include: General MCH services such as providing the core public health functions of assessment, policy development and assurance as it relates to the MCH population in Orange County; and Perinatal Access coordination including the Comprehensive Perinatal Services Program (CPSP) and perinatal outreach and education services for Medi-Cal eligible pregnant women. Perinatal Support Services (PSS) is the designation given to CalOptima’s version of the State’s CPSP. PSS includes a comprehensive initial risk assessment addressing medical, nutritional, health education and psychosocial risks at the initiation of pregnancy related services. Formal re-assessments must be followed up by interventions designed to ameliorate the condition or problem in a prioritized manner. Administration Operate an organized program that is designed to assess the ongoing health needs of the MCH population in Orange County, and to stimulate/participate in collaborative efforts which build community capacity to meet these needs, both in the public and private sectors. Inform and advise health plans, providers and the general community on the health status of the MCH population in Orange County. CalOptima will be financially responsible for the medical services of CalOptima members, as described in contractual requirements, and ensure that CalOptima Health Networks and providers provide these services. Data Collection County/MCH is responsible for ongoing collection and review of health status indicators such as maternal and infant morbidity and mortality. Inform CalOptima of local status and trends toward achievement of MCH Year 2020 objectives. CalOptima will work with Health Networks and providers to develop a methodology for collecting data on service utilization and health status of enrolled members in accordance with CDHCS requirements. CalOptima will report HEDIS measures annually. Planning Collaborate with CalOptima in identifying MCH population service needs or gaps, inclusive of CalOptima members, and developing a plan to address identified needs with attention to the special areas of language capability, cultural competence and literacy. Collaborate with County/MCH in identifying MCH population service needs or gaps, inclusive of CalOptima members, and developing a plan to address identified needs with attention to the special areas of language capability, cultural competence and literacy. Client Outreach Provide outreach to women and their infants, children, adolescents to inform Inform CalOptima members at the time of enrollment of their NOTE: Clients are individuals who may be eligible to receive or are receiving Medi-Cal benefits. them of their potential eligibility for Medi-Cal, encourage them to apply for benefits and assist in application process. Responsible for outreaching to potentially eligible pregnant women and those who may become pregnant to assist them in enrolling in early and continuous prenatal care. Work closely with community groups; including CalOptima, regarding access to care issues for women, infants, children, and adolescents. Promote the toll-free MCH Health Referral Line (HRL) telephone number to assist women and their infants, children and adolescents in accessing available health and medical care and support services. QUALITY ASSURANCE: Outreach efforts will be monitored and evaluated by maintaining a count of the number of calls to the HRL as a result of each outreach campaign. entitlement to MCH services including, but not limited to, PSS. CalOptima staff will be available to assist eligible members in making informed decisions in selecting providers and enrolling in preferred Health Networks. CalOptima Health Networks and providers will inform eligible members of available perinatal services, encourage early and continuous perinatal care, and assist in accessing such services. Require Health Networks to ensure that the contracted PSS vendor or perinatal provider inform and offer PSS to Health Network members. QUALITY ASSURANCE: CalOptima will review provider reports for the referral to or provision of comprehensive perinatal support services. Client Services Information and Education Responsible for community-wide public education on pregnancy, perinatal care, and the support services needs of pregnant women, including CPSP services, in cooperation with CalOptima. QUALITY ASSURANCE: Documentation of community information and training activities will be maintained on file with participant evaluations, as appropriate. Participate with County/MCH in communitywide public education on pregnancy, perinatal care, and the support services needs of pregnant women, including PSS. Target education to Medi-Cal and other low-income residents. QUALITY ASSURANCE: Documentation of community information and training activities will be maintained on file with participant evaluations, as appropriate Case Management/ Tracking and Follow- Up Responsible for tracking and follow-up of non-CalOptima targeted pregnant women to determine if they received a Medi-Cal application, completed processing and are enrolled in prenatal Responsible for assuring that all enrolled high-risk women are being case managed. Encourage providers to give Category County/MCH CalOptima/Health Networks care. Inform CalOptima Health Networks and providers of perinatal resources available to members no longer eligible for CalOptima Medi-Cal benefits, including the toll-free County/Health Referral telephone number for access to other health resources. Xxxxxx identified former CalOptima members, i.e., those no longer eligible for Medi-Cal benefits and with no medical provider, in writing, about services available to non-Medi-Cal low-income women. QUALITY ASSURANCE: Maintain tracking system of pregnant women enrolled in County/MCH/Perinatal outreach and education services documenting essential perinatal indicators (by trimester of enrollment, by trimester of initiation of prenatal care, by number of prenatal visits, and by outcome of pregnancy.) resource information for continuing perinatal care (i.e., County/Health Referral toll-free number) to pregnant women who have lost CalOptima eligibility. Ensure that providers are responsible for: basic case management; coordination of medical/social referrals (including Supplemental Nutrition for Women, Infants and Children (WIC); Genetic screening and Counseling) and follow-up on missed appointments. QUALITY ASSURANCE: Review of reports for timely completion of risk assessments according to Title 22, California Code of Regulations and the DHCS State contract requirements.

Family Planning. The Orange County Health Care Agency is a FamilyPACT provider of family planning and pregnancy testing services. Services are provided in accordance with regulations specified by State Office of Family Planning (OFP) and Title X regulations and guidelines. The Standards of Care, promulgated by the State in cooperation with the American College of Obstetricians and Gynecologists (ACOG) and Title X, are the required level of care for all family planning providers and are used as a basis for evaluation of services. Eligibility/ Client Services County/Family Planning will provide family planning services to FamilyPACT eligible CalOptima Direct or CalOptima Health Network members choosing to seek such services outside of their Health Network or CalOptima. CalOptima recognizes that CalOptima Direct or CalOptima Health Network members have the right to choose to seek their family planning services outside of the Health Network/CalOptima. Upon request, CalOptima will provide Health Networks and providers information about low cost/free family planning services for members who lose eligibility. CalOptima, its Health Networks and providers will not require prior authorization for in-network or out- of-network family planning services. CalOptima, its Health Networks and providers will not require parental consent for family planning services for a member under 21 years. QUALITY ASSURANCE: CalOptima will respond to issues of Health Networks inappropriately requesting prior authorization for family planning services, and will take necessary corrective action. Follow-Up Services CalOptima beneficiaries receiving family planning services at County Family Planning clinics who require follow-up of complications associated with contraceptive methods either beyond the scope of practice of County Family Planning clinics or not covered by the DHS definition of family CalOptima Health Networks and Providers will provide family planning services and/or care of complications associated with contraceptive methods either beyond the scope of practice of County Family Planning clinics or not Orange County Health Care Agency- Public Health Coordination and Provision of Public Health Care Services Contract_Medi-Cal June I, 2013 CATEGORY County Family Planning Plannin2 Clinic CalOptima/Health Networks planning services will be referred to their CalOptima Health Network provider for continuing care. covered by the DHS definition of family planning services to CalOptima members referred by County Family Planning clinics. Provider Network Education County Health Referral Line will provide CalOptima members upon request with community and public family planning resources, as well as, providers who are able to provide special linguistic and/or culturally competent services. CalOptima is responsible to ensure that Health Networks and providers are aware that CalOptima members have freedom of choice of family planning services and providers, including out of network providers, without prior authorization. Orange County Health Care Agency- Public Health Coordination and Provision of Public Health Care Services Contract_Medi-Cal June I, 2013 State and Federal regulations mandate the County/MCH Program to promote comprehensive women's and children's health services to meet community needs within the County. Responsibilities include: General MCH services such as providing the core public health functions of assessment, policy development and assurance as it relates to the MCH population in Orange County; and Perinatal Access coordination including the Comprehensive Perinatal Services Program (CPSP) and perinatal outreach and education services for Medi-Cal eligible pregnant women. Perinatal Support Services (PSS) is the designation given to CalOptima’s 's version of the State’s 's CPSP. PSS includes a comprehensive initial risk assessment addressing medical, nutritional, health education and psychosocial risks at the initiation of pregnancy related services. Formal re-assessments must be followed up by interventions designed to ameliorate the condition or problem in a prioritized manner. Administration Operate an organized program that is designed to assess the ongoing health needs of the MCH population in Orange County, and to stimulate/participate in collaborative efforts which build community capacity to meet these needs, both in the public and private sectors. Inform and advise health plans, providers and the general community on the health status of the MCH population in Orange County. CalOptima will be financially responsible for the medical services of CalOptima members, as described in contractual requirements, and ensure that CalOptima Health Networks and providers provide these services. Data Collection County/MCH is responsible for ongoing collection and review of health status indicators such as maternal and infant morbidity and mortality. Inform CalOptima of local oflocal status and trends toward achievement of MCH Year 2020 objectives. CalOptima will work with Health Networks and providers to develop a methodology for collecting data on service utilization and health status of enrolled members in accordance with CDHCS requirementsrequirements . CalOptima will report HEDIS measures annually. Planning Collaborate with CalOptima in identifying MCH population service needs or gaps, inclusive of CalOptima members, and developing a plan to address identified needs with attention to the special areas of language capability, cultural competence and literacy. Collaborate with County/MCH in identifying MCH population service needs or gaps, inclusive of CalOptima members, and developing a plan to address identified needs with attention to the special areas of language capability, cultural competence and literacy. Client Outreach Provide outreach to women and their Inform CalOptima members at the Orange County Health Care Agency- Public Health Coordination and Provision of Public Health Care Services Contract_Medi-Cal June I, 2013 Category County/MCH CalOptima/Health Networks infants, children, adolescents to inform Inform CalOptima members at the time of enrollment of their NOTE: Clients are individuals who may be eligible to receive or are receiving Medi-Cal benefits. them of their potential eligibility for entitlement to MCH services individuals who may be Medi-Cal, encourage them to apply for including, but not limited to, PSS. eligible to receive or are benefits and assist in application receiving Medi-Cal process. CalOptima staff will be available to benefits. assist eligible members in making Responsible for outreaching to informed decisions in selecting potentially eligible pregnant women providers and enrolling in preferred and those who may become pregnant Health Networks. to assist them in enrolling in early and continuous prenatal care. CalOptima Health Networks and providers will inform eligible members of available perinatal Work closely with community groups; services, encourage early and including CalOptima, regarding access continuous perinatal care, and assist to care issues for women, infants, in accessing such services. children, and adolescents. Require Health Networks to ensure Promote the toll-free MCH Health that the contracted PSS vendor or Referral Line (HRL) telephone number perinatal provider inform and offer to assist women and their infants, PSS to Health Network members. children and adolescents in accessing available health and medical care and QUALITY ASSURANCE: support services. CalOptima will review provider reports for the referral to or QUALITY ASSURANCE: Outreach provision of comprehensive efforts will be monitored and evaluated perinatal support services. by maintaining a count of the number of calls to the HRL as a result of each outreach campaign. entitlement to MCH services including, but not limited to, PSS. CalOptima staff will be available to assist eligible members in making informed decisions in selecting providers and enrolling in preferred Health Networks. CalOptima Health Networks and providers will inform eligible members of available perinatal services, encourage early and continuous perinatal care, and assist in accessing such services. Require Health Networks to ensure that the contracted PSS vendor or perinatal provider inform and offer PSS to Health Network members. QUALITY ASSURANCE: CalOptima will review provider reports for the referral to or provision of comprehensive perinatal support services. Client Services Information and Education Responsible for community-wide public education on pregnancy, perinatal care, and the support services needs of pregnant women, including CPSP services, in cooperation with CalOptima. QUALITY ASSURANCE: Documentation of community information and training activities will be maintained on file with participant evaluations, as appropriate. Participate with County/MCH in communitywide public education on pregnancy, perinatal care, and the support services needs of pregnant women, including PSS. Target education to Medi-Cal and other low-income residents. QUALITY ASSURANCE: Documentation of community information and training activities will be maintained on file with participant evaluations, as appropriate Case Management/ Tracking and Follow- Up Responsible for tracking and follow-up of non-CalOptima targeted pregnant women to determine if they received a Medi-Cal application, completed processing and are enrolled in prenatal Responsible for assuring that all enrolled high-risk women are being case managed. Encourage providers to give Orange County Health Care Agency- Public Health Coordination and Provision of Public Health Care Services Contract_Medi-Cal Junel,2013 Category County/MCH CalOptima/Health Networks Medi-Cal application, completed processing and are enrolled in prenatal care. Inform CalOptima Health Networks and providers of perinatal resources available to members no longer eligible for CalOptima Medi-Cal benefits, including the toll-free County/Health Referral telephone number for access to other health resources. Xxxxxx Advise identified former CalOptima members, i.e., those no longer eligible for Medi-Cal benefits and with no medical provider, in writing, about services available to non-Medi-Cal low-income women. QUALITY ASSURANCE: Maintain tracking system of pregnant women enrolled in County/MCH/Perinatal outreach and education services documenting essential perinatal indicators (by trimester of enrollment, by trimester of initiation of prenatal care, by number of prenatal visits, and by outcome of pregnancy.) Encourage providers to give resource information for continuing perinatal care (i.e., County/Health Referral toll-free number) to pregnant women who have lost CalOptima eligibility. Ensure that providers are responsible for: basic case management; coordination of medical/social referrals (including Supplemental Nutrition for Women, Infants and Children (WIC); Genetic screening and Counseling) and follow-up on missed appointments. QUALITY ASSURANCE: Review of reports for timely completion of risk assessments according to Title 22, California Code of Regulations and the DHCS State contract requirements.

Family Planning. The Orange County Health Care Agency is a FamilyPACT provider of family planning and pregnancy testing services. Services are provided in accordance with regulations specified by State Office of Family Planning (OFP) and Title X regulations and guidelines. The Standards of Care, promulgated by the State in cooperation with the American College of Obstetricians and Gynecologists (ACOG) and Title X, are the required level of care for all family planning providers and are used as a basis for evaluation of services. Eligibility/ Client Services County/Family Planning will provide family planning services to FamilyPACT eligible CalOptima Direct or CalOptima Health Network members choosing to seek such services outside of their Health Network or CalOptima. CalOptima recognizes that CalOptima Direct or CalOptima Health Network members have the right to choose to seek their family planning services outside of the Health Network/CalOptima. Upon request, CalOptima will provide Health Networks and providers information about low cost/free family planning services for members who lose eligibility. CalOptima, its Health Networks and providers will not require prior authorization for in-network or out- of-network family planning services. CalOptima, its Health Networks and providers will not require parental consent for family planning services for a member under 21 years. QUALITY ASSURANCE: CalOptima will respond to issues of Health Networks inappropriately requesting prior authorization for family planning services, and will take necessary corrective action. Follow-Up Services CalOptima beneficiaries receiving family planning services at County Family Planning clinics who require follow-up of complications associated with contraceptive methods either beyond the scope of practice of County Family Planning clinics or not covered by the DHS definition of family planning services will be referred to their CalOptima Health Network provider for CalOptima Health Networks and Providers will provide family planning services and/or care of complications associated with contraceptive methods either beyond the scope of practice of County Family Planning clinics or not CATEGORY County Family Planning Clinic CalOptima/Health Networks planning services will be referred to their CalOptima Health Network provider for continuing care. covered by the DHS definition of family planning services to CATEGORY County Family Planning Clinic CalOptima/Health Networks continuing care. CalOptima members referred by County Family Planning clinics. Provider Network Education County Health Referral Line will provide CalOptima members upon request with community and public family planning resources, as well as, providers who are able to provide special linguistic and/or culturally competent services. CalOptima is responsible to ensure that Health Networks and providers are aware that CalOptima members have freedom of choice of family planning services and providers, including out of network providers, without prior authorization. State and Federal regulations mandate the County/MCH Program to promote comprehensive women's and children's health services to meet community needs within the County. Responsibilities include: General MCH services such as providing the core public health functions of assessment, policy development and assurance as it relates to the MCH population in Orange County; and Perinatal Access coordination including the Comprehensive Perinatal Services Program (CPSP) and perinatal outreach and education services for Medi-Cal eligible pregnant women. Perinatal Support Services (PSS) is the designation given to CalOptima’s version of the State’s CPSP. PSS includes a comprehensive initial risk assessment addressing medical, nutritional, health education and psychosocial risks at the initiation of pregnancy related services. Formal re-assessments must be followed up by interventions designed to ameliorate the condition or problem in a prioritized manner. Administration Operate an organized program that is designed to assess the ongoing health needs of the MCH population in Orange County, and to stimulate/participate in collaborative efforts which build community capacity to meet these needs, both in the public and private sectors. Inform and advise health plans, providers and the general community on the health status of the MCH population in Orange County. CalOptima will be financially responsible for the medical services of CalOptima members, as described in contractual requirements, and ensure that CalOptima Health Networks and providers provide these services. Data Collection County/MCH is responsible for ongoing collection and review of health status indicators such as maternal and infant morbidity and mortality. Inform CalOptima of local status and trends toward achievement of MCH Year 2020 objectives. CalOptima will work with Health Networks and providers to develop a methodology for collecting data on service utilization and health status of enrolled members in accordance with CDHCS requirements. CalOptima will report HEDIS measures annually. Planning Collaborate with CalOptima in identifying MCH population service needs or gaps, inclusive of CalOptima members, and developing a plan to address identified needs with attention to the special areas of language capability, cultural competence and literacy. Collaborate with County/MCH in identifying MCH population service needs or gaps, inclusive of CalOptima members, and developing a plan to address identified needs with attention to the special areas of language capability, cultural competence and literacy. Client Outreach Provide outreach to women and their infants, children, adolescents to inform Inform CalOptima members at the time of enrollment of their NOTE: Clients are individuals who may be eligible to receive or are receiving Medi-Cal benefits. them of their potential eligibility for Medi-Cal, encourage them to apply for benefits and assist in application process. Responsible for outreaching to potentially eligible pregnant women and those who may become pregnant to assist them in enrolling in early and continuous prenatal care. Work closely with community groups; including CalOptima, regarding access to care issues for women, infants, children, and adolescents. Promote the toll-free MCH Health Referral Line (HRL) telephone number to assist women and their infants, children and adolescents in accessing available health and medical care and support services. QUALITY ASSURANCE: Outreach efforts will be monitored and evaluated by maintaining a count of the number of calls to the HRL as a result of each outreach campaign. entitlement to MCH services including, but not limited to, PSS. CalOptima staff will be available to assist eligible members in making informed decisions in selecting providers and enrolling in preferred Health Networks. CalOptima Health Networks and providers will inform eligible members of available perinatal services, encourage early and continuous perinatal care, and assist in accessing such services. Require Health Networks to ensure that the contracted PSS vendor or perinatal provider inform and offer PSS to Health Network members. QUALITY ASSURANCE: CalOptima will review provider reports for the referral to or provision of comprehensive perinatal support services. Client Services Information and Education Responsible for community-wide public education on pregnancy, perinatal care, and the support services needs of pregnant women, including CPSP services, in cooperation with CalOptima. QUALITY ASSURANCE: Documentation of community information and training activities will be maintained on file with participant evaluations, as appropriate. Participate with County/MCH in communitywide public education on pregnancy, perinatal care, and the support services needs of pregnant women, including PSS. Target education to Medi-Cal and other low-income residents. QUALITY ASSURANCE: Documentation of community information and training activities will be maintained on file with participant evaluations, as appropriate Case Management/ Tracking and Follow- Up Responsible for tracking and follow-up of non-CalOptima targeted pregnant women to determine if they received a Medi-Cal application, completed processing and are enrolled in prenatal Responsible for assuring that all enrolled high-risk women are being case managed. Encourage providers to give Category County/MCH CalOptima/Health Networks care. Inform CalOptima Health Networks and providers of perinatal resources available to members no longer eligible for CalOptima Medi-Cal benefits, including the toll-free County/Health Referral telephone number for access to other health resources. Xxxxxx identified former CalOptima members, i.e., those no longer eligible for Medi-Cal benefits and with no medical provider, in writing, about services available to non-Medi-Cal low-income women. QUALITY ASSURANCE: Maintain tracking system of pregnant women enrolled in County/MCH/Perinatal outreach and education services documenting essential perinatal indicators (by trimester of enrollment, by trimester of initiation of prenatal care, by number of prenatal visits, and by outcome of pregnancy.) resource information for continuing perinatal care (i.e., County/Health Referral toll-free number) to pregnant women who have lost CalOptima eligibility. Ensure that providers are responsible for: basic case management; coordination of medical/social referrals (including Supplemental Nutrition for Women, Infants and Children (WIC); Genetic screening and Counseling) and follow-up on missed appointments. QUALITY ASSURANCE: Review of reports for timely completion of risk assessments according to Title 22, California Code of Regulations and the DHCS State contract requirements.