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 XXXXX, 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 limited to: a. Intensive Care Coordination; b. Family Support and Training Services; c. In-Home Behavioral Services (including Behavior Management Therapy and Behavior Management Monitoring); d. Therapeutic Mentoring Services; e. In-Home Therapy Services (including Therapeutic Clinical Intervention and Ongoing Therapeutic Training and Support); and f. Youth Mobile Crisis Intervention Services (MCI); 7. Ensure that all Enrollees have access to emergency Behavioral Health Services, including immediate and unrestricted access to Emergency Services Program and Mobile Crisis Intervention services at hospital emergency departments and in the community, 24 hours a day, seven days a week; 8. Ensure that criminal justice involved Enrollees have access to medically necessary services, including Behavioral Health Services, and Care Management and care coordination as appropriate, as otherwise provided in this Contract. 9. Follow up with an Enrollee within 24 hours of when the Enrollee accesses emergency Behavioral Health Services, including ESP and MCI services; 10. Develop, implement, and maintain Wellness Initiatives as follows and as further directed by XXXXX: a. Such Wellness Initiatives may include, but are not limited to, programs such as: 1) General health education classes, including how to access appropriate levels of health care; 2) Tobacco cessation programs, with targeted outreach for adolescents and pregnant individuals; 3) Childbirth education classes;
Appears in 4 contracts
Samples: Primary Care Accountable Care Organization Contract, Primary Care Accountable Care Organization Contract, Primary Care Accountable Care Organization Contract
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: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;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 XXXXXEOHHS, 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 limited to:to:
a. Intensive Care Coordination;
b. Family Support and Training Services;
c. In-Home Behavioral Services (including Behavior Management Therapy and Behavior Management Monitoring);
d. Therapeutic Mentoring Services;
e. In-Home Therapy Services (including Therapeutic Clinical Intervention and Ongoing Therapeutic Training and Support); and
f. Youth Mobile Crisis Intervention Services (MCI);
7. Ensure that all Enrollees have access to emergency Behavioral Health Services, including immediate and unrestricted access to Emergency Services Program and Mobile Crisis Intervention services at hospital emergency departments and in the community, 24 hours a day, seven days a week;week;
8. Ensure that criminal justice involved Enrollees have access to medically necessary services, including Behavioral Health Services, and Care Management and care coordination as appropriate, as otherwise provided in this Contract.
9. Follow up with an Enrollee within 24 hours of when the Enrollee accesses emergency Behavioral Health Services, including ESP and MCI services;services;
10. Develop, implement, and maintain Wellness Initiatives as follows and as further directed by XXXXXEOHHS:
a. Such Wellness Initiatives may include, but are not limited to, programs such as:
1) General health education classes, including how to access appropriate levels of health care;
2) Tobacco cessation programs, with targeted outreach for adolescents and pregnant individualswomen;
3) Childbirth education classes;
Appears in 2 contracts
Samples: Contract for Primary Care Accountable Care Organization Services, Contract
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:access:
a. As x. Xx 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 x. Xxxx 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;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 XXXXXEOHHS, 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 limited to:to:
a. Intensive Care Coordination;
b. Family x. Xxxxxx Support and Training Services;
c. In-Home Behavioral Services (including Behavior Management Therapy and Behavior Management Monitoring);
d. Therapeutic Mentoring Services;
e. In-Home Therapy Services (including Therapeutic Clinical Intervention and Ongoing Therapeutic Training and Support); and
f. Youth Mobile Crisis Intervention Services (MCI);
7. Ensure that all Enrollees have access to emergency Behavioral Health Services, including immediate and unrestricted access to Emergency Services Program and Mobile Crisis Intervention services at hospital emergency departments and in the community, 24 hours a day, seven days a week;week;
8. Ensure that criminal justice involved Enrollees have access to medically necessary services, including Behavioral Health Services, and Care Management and care coordination as appropriate, as otherwise provided in this Contract.
9. Follow up with an Enrollee within 24 hours of when the Enrollee accesses emergency Behavioral Health Services, including ESP and MCI services;services;
10. Develop, implement, and maintain Wellness Initiatives as follows and as further directed by XXXXXEOHHS:
a. Such Wellness Initiatives may include, but are not limited to, programs such as:
1) General health education classes, including how to access appropriate levels of health care;
2) Tobacco cessation programs, with targeted outreach for adolescents and pregnant individualswomen;
3) Childbirth education classes;
Appears in 1 contract
Samples: Primary Care Accountable Care Organization Contract
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: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;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 XXXXX, 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 limited to:to:
a. Intensive Care Coordination;
b. Family Support and Training Services;
c. In-Home Behavioral Services (including Behavior Management Therapy and Behavior Management Monitoring);
d. Therapeutic Mentoring Services;
e. In-Home Therapy Services (including Therapeutic Clinical Intervention and Ongoing Therapeutic Training and Support); and
f. Youth Mobile Crisis Intervention Services (MCI);
7. Ensure that all Enrollees have access to emergency Behavioral Health Services, including immediate and unrestricted access to Emergency Services Program and Mobile Crisis Intervention services at hospital emergency departments and in the community, 24 hours a day, seven days a week;week;
8. Ensure that criminal justice involved Enrollees have access to medically necessary services, including Behavioral Health Services, and Care Management and care coordination as appropriate, as otherwise provided in this Contract.
9. Follow up with an Enrollee within 24 hours of when the Enrollee accesses emergency Behavioral Health Services, including ESP and MCI services;services;
10. Develop, implement, and maintain Wellness Initiatives as follows and as further directed by XXXXX:
a. Such Wellness Initiatives may include, but are not limited to, programs such as:
1) General health education classes, including how to access appropriate levels of health care;
2) Tobacco cessation programs, with targeted outreach for adolescents and pregnant individualswomen;
3) Childbirth education classes;
Appears in 1 contract
Samples: Contract for Primary Care Accountable Care Organization Services
General Care Delivery Requirements. The Each of the Contractor’s Approved ACO Agreements with a Contracting MCO shall delineate responsibilities and define areas of collaboration between the Contractor shall and the Contracting MCO, including obligating the Contractor as appropriate, to ensure that all Enrollees Attributed Members receive care that is timely, accessible, and Culturally and Linguistically Competent. The Contractor shall:, as set forth in this Section.
1. Ensure The Approved ACO Agreement shall obligate the Contractor to ensure that all Enrollees Attributed Members may access: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 EnrolleeAttributed Member;
c. Care that is Culturally and Linguistically Competent. The Contractor shall regularly evaluate the population of Enrollees Attributed Members to identify language needs, including needs experienced by Enrollees Attributed Members 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). 2.5.B. The Contractor shall identify opportunities to improve the availability of fluent staff or skilled translation services in EnrolleesAttributed Members’ preferred languages and opportunities to improve the cultural appropriateness of EnrolleesAttributed Members’ care; and;
d. All Medically Necessary services, including Behavioral Health Services, other specialty services, and any other services delivered to the Enrollee Attributed Member by entities other than the Contractor, in a timely, coordinated, and person-centered manner and in accordance with the EnrolleeAttributed Member’s wishes, as necessary and appropriate;; and
2. The Approved ACO Agreement shall delineate responsibilities and define areas of collaboration between the Contractor and the Contracting MCO, including obligating the Contractor as appropriate, to:
a. Ensure that each EnrolleeAttributed Member, including but not limited to Enrollees Attributed Members with Special Health Care Needs, has access to Providers providers with expertise in treating the full range of medical conditions of the EnrolleeAttributed Member;
3. b. Perform coordination to assist Enrollees Attributed Members with accessing transportation to medical appointments, where Medically Necessary, for the Enrollee Attributed Member to access medical care;care;
4. c. Ensure provision of Early Periodic Screening, Diagnosis, and Treatment (EPSDT) and Preventive Pediatric Health Care Screening and Diagnosis (PPHSD) services to all Enrollees Attributed Members under the age of 21;
5. d. Ensure the use of the CANS Tool by appropriately qualified Primary Care and Behavioral Health Providers providers for all Enrollees Attributed Members under the age of 21, as further directed by XXXXXEOHHS, and otherwise ensure that Enrollees Attributed Members under the age of 21 have access to appropriate care;
6. e. Ensure that all Enrollees Attributed Members 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 limited to:to:
a. 1) Intensive Care Coordination;
b. 2) Family Support and Training Services;
c. 3) In-Home Behavioral Services (including Behavior Management Therapy and Behavior Management Monitoring);
d. Therapeutic Mentoring Services;
e. In-Home Therapy Services (including Therapeutic Clinical Intervention and Ongoing Therapeutic Training and Support); and
f. Youth Mobile Crisis Intervention Services (MCI);
7. Ensure that all Enrollees have access to emergency Behavioral Health Services, including immediate and unrestricted access to Emergency Services Program and Mobile Crisis Intervention services at hospital emergency departments and in the community, 24 hours a day, seven days a week;
8. Ensure that criminal justice involved Enrollees have access to medically necessary services, including Behavioral Health Services, and Care Management and care coordination as appropriate, as otherwise provided in this Contract.
9. Follow up with an Enrollee within 24 hours of when the Enrollee accesses emergency Behavioral Health Services, including ESP and MCI services;
10. Develop, implement, and maintain Wellness Initiatives as follows and as further directed by XXXXX:
a. Such Wellness Initiatives may include, but are not limited to, programs such as:
1) General health education classes, including how to access appropriate levels of health care;
2) Tobacco cessation programs, with targeted outreach for adolescents and pregnant individuals;
3) Childbirth education classes;
Appears in 1 contract
Samples: Contract for Mco Administered Accountable Care Organization
