General Care Delivery Requirements Sample Clauses
The General Care Delivery Requirements clause sets out the fundamental standards and obligations that a healthcare provider must meet when delivering care to patients. It typically outlines expectations such as maintaining appropriate licensure, adhering to professional standards, and ensuring that care is provided in a safe and effective manner. For example, it may require providers to follow evidence-based practices or comply with all applicable laws and regulations. The core function of this clause is to ensure that patients receive consistent, high-quality care and to establish clear benchmarks for provider performance.
General Care Delivery Requirements. The Contractor shall ensure that all Enrollees receive care that is timely, accessible, and Culturally and Linguistically Competent. The Contractor shall:
1. Ensure that all Enrollees may access:
a. As further specified by EOHHS, Primary Care or Urgent Care during extended hours to reduce avoidable inpatient admissions and emergency department visits;
b. Medical and diagnostic equipment that is accessible to the Enrollee;
c. Care that is Culturally and Linguistically Competent. The Contractor shall regularly evaluate the population of Enrollees to identify language needs, including needs experienced by Enrollees who are deaf or hard of hearing, and needs related to health literacy, and to identify needs related to cultural appropriateness of care (including through the Care Needs Screening as described in Section 2.3.B). The Contractor shall identify opportunities to improve the availability of fluent staff or skilled translation services in Enrollees’ preferred languages and opportunities to improve the cultural appropriateness of Enrollees’ care; and
d. All Medically Necessary services, including Behavioral Health Services, other specialty services, and any other services delivered to the Enrollee by entities other than the Contractor, in a timely, coordinated, and person-centered manner and in accordance with the Enrollee’s wishes, as necessary and appropriate;
2. Ensure that each Enrollee, including but not limited to Enrollees with Special Health Care Needs, has access to Providers with expertise in treating the full range of medical conditions of the Enrollee;
3. Perform coordination to assist Enrollees with accessing transportation to medical appointments, where Medically Necessary, for the Enrollee to access medical care;
4. Ensure provision of Early Periodic Screening, Diagnosis, and Treatment (EPSDT) and Preventive Pediatric Health Care Screening and Diagnosis (PPHSD) services to all Enrollees under the age of 21;
5. Ensure the use of the CANS Tool by appropriately qualified Primary Care and Behavioral Health Providers for all Enrollees under the age of 21, as further directed by ▇▇▇▇▇, and otherwise ensure that Enrollees under the age of 21 have access to appropriate care;
6. Ensure that all Enrollees under the age of 21 have access to Medically Necessary services under the Children’s Behavioral Health Initiative, including through partnering with Community Service Agencies, as identified by EOHHS. Such services shall include but not be limite...
General Care Delivery Requirements. In accordance with all other applicable Contractor requirements, the Contractor shall ensure that all Enrollees receive care that is timely, accessible, and Linguistically and Culturally Competent. The Contractor shall:
1. Ensure that all Enrollees may access:
a. Primary Care or Urgent Care during extended hours;
b. Same-day appointments for certain services;
c. Medical and diagnostic equipment that is accessible to Enrollees;
d. Care that is Linguistically and Culturally Competent. The Contractor shall regularly evaluate the population of Enrollees to identify language needs, including needs experienced by Enrollees who are deaf or hard of hearing, and needs related to health literacy, and to identify needs related to cultural appropriateness of care (including through the Care Needs Screening as described in Section 2.5.B). The Contractor shall identify opportunities to improve the availability of fluent staff or skilled translation services in Enrollees’ preferred languages and opportunities to improve the cultural appropriateness of Enrollees’ care;
e. All Medically Necessary Services, including Behavioral Health Services and other specialty services, in accordance with the Enrollee’s wishes and in a timely, coordinated, and person-centered manner. Contractor shall make best efforts to ensure timely, coordinated, and person-centered access to all such services for the Enrollee in accordance with the Enrollee’s wishes, including any other services delivered to the Enrollee by entities other than the Contractor, as necessary and appropriate;
2. Ensure each Enrollee’s access to Providers with expertise in treating the full range of medical conditions of the Enrollee, including but not limited to Enrollees with Special Health Care Needs;
General Care Delivery Requirements. In accordance with all other applicable Contractor requirements, the Contractor shall ensure that all Enrollees receive appropriate care. The Contractor shall:
1. Ensure that all Enrollees may access:
a. Care that is timely, accessible, and Culturally and Linguistically Appropriate. The Contractor shall regularly evaluate the population of Enrollees to identify language needs, including needs experienced by Enrollees who are deaf or hard of hearing, and needs related to health literacy, and to identify needs related to cultural appropriateness of care (including through the Care Needs Screening as described in Section 2.3.B.
General Care Delivery Requirements. Each of the Contractor’s Approved ACO Agreements with an MCO-Administered ACO shall delineate responsibilities and define areas of collaboration between the Contractor and the MCO-Administered ACO as set forth in this Section.
1. The Approved ACO Agreement shall obligate the MCO-Administered ACO to ensure that all Attributed Members:
a. Receive care that is timely, accessible, and Culturally and Linguistically Appropriate; and
b. Access care as described in Section 2.5 of the Contract;
2. The Approved ACO Agreement shall delineate responsibilities and define areas of collaboration between the Contractor and the MCO-Administered ACO to ensure all requirements in Section 2.5.A of the Contract are met.
General Care Delivery Requirements. In accordance with all other applicable Contractor requirements, the Contractor shall ensure that all Enrollees receive care that is timely, accessible, and Linguistically and Culturally Competent. The Contractor shall:
General Care Delivery Requirements. Each of the Contractor’s Approved ACO Agreements with an MCO-Administered ACO shall delineate responsibilities and define areas of collaboration between the Contractor and the MCO-Administered ACO as set forth in this Section.
1. The Approved ACO Agreement shall obligate the MCO-Administered ACO to ensure that all Attributed Members: