Common use of FIDE Care Coordination Requirements Clause in Contracts

FIDE Care Coordination Requirements. Through the FIDE-designated PBP in Section 4 of this Agreement, MAO to only enroll eligible ALTCS E-PD health plan Dual Eligible Members, and agrees to cover all costs incurred for benefits by its enrolled ALTCS E-PD program Dual Eligible Members, as listed in this Agreement. MAO agrees to coordinate and arrange the delivery of covered Medicare and Medicaid health and long-term care services, using aligned care management and specialty care network methods for high-risk beneficiaries, components shall include, but are not limited to:  Enroll special needs individuals entitled to medical assistance under a Medicaid State Plan, as defined in Section 1859(b)(6)(B)(ii) of the Act and 42 CFR Section 422.2, and as described at Section 40.5.3 of Chapter 16b of the Medicare Managed Care Manual;  Provide access to Medicare and Medicaid benefits under a single managed care entity;  Have a CMS-approved, MIPPA compliant contract with a State Medicaid Agency that includes coverage of specified primary, acute, and long-term care benefits and services, consistent with State policy, under risk-based financing;  Coordinate the delivery of covered Medicare and Medicaid health and long- term care services, using aligned care management and specialty care network methods for high-risk beneficiaries; and  Provide a long-term care case manager who manages care transitions and assists ALTCS E-PD program enrolled Dual Eligible Members to access the full range of their medically necessary Medicare and Medicaid benefits, as per ALTCS Health Plan contract paragraph D.17: Case Management.

FIDE Care Coordination Requirements. Through the FIDE-designated PBP in Section 4 of this Agreement, MAO to only enroll eligible ALTCS E-PD health plan Dual Eligible Members, and agrees to cover all costs incurred for benefits by its enrolled ALTCS E-PD program Dual Eligible Members, as listed in this Agreement. MAO XXX agrees to coordinate and arrange the delivery of covered Medicare and Medicaid health and long-term care services, using aligned care management and specialty care network methods for high-risk beneficiaries, components shall include, but are not limited to:  • Enroll special needs individuals entitled to medical assistance under a Medicaid State Plan, as defined in Section 1859(b)(6)(B)(ii) of the Act and 42 CFR Section 422.2, and as described at Section 40.5.3 of Chapter 16b of the Medicare Managed Care Manual;  • Provide access to Medicare and Medicaid benefits under a single managed care entity;  • Have a CMS-approved, MIPPA compliant contract with a State Medicaid Agency that includes coverage of specified primary, acute, and long-term care benefits and services, consistent with State policy, under risk-based financing;  • Coordinate the delivery of covered Medicare and Medicaid health and long- term care services, using aligned care management and specialty care network methods for high-risk beneficiaries; and  • Provide a long-term care case manager who manages care transitions and assists ALTCS E-PD program enrolled Dual Eligible Members to access the full range of their medically necessary Medicare and Medicaid benefits, as per ALTCS Health Plan contract paragraph D.17: Case Management.