Health Homes Sample Clauses

Health Homes. The CONTRACTOR shall comply and cooperate with HCA’s Health Home initiative for developing Behavioral Health Homes and Physical Health Homes as authorized under Section 2703 of the PPACA. The CONTRACTOR shall implement Health Homes in accordance with New Mexico’s Medicaid State Plan, the Managed Care Policy Manual, and the CareLink New Mexico Health Homes Policy Manual. The CONTRACTOR shall make best efforts to contract with all Health Home Providers designated by HCA and the CareLink New Mexico Steering Committee. The CONTRACTOR shall refer all eligible Members who meet the CareLink New Mexico Health Home criteria and who are not participating in a Full Delegation of Care Coordination model to one (1) of the CareLink New Mexico Health Homes and document all such referrals. The CONTRACTOR shall also maintain a record of any Member choice to opt in or out of the Health Home or to select a different CareLink New Mexico Provider. The CONTRACTOR shall ensure that Health Home Providers provide Care Coordination functions for Members enrolled with the Health Home. The CONTRACTOR shall maintain administrative responsibility and oversight of Care Coordination and reporting as required by HCA according to this Agreement. The CONTRACTOR shall issue monthly payments to Health Home Provider(s) when the Health Home Provider has submitted Claims to the CONTRACTOR documenting the utilization of Health Home services by a Member per the CareLink New Mexico Provider Policy Manual. The costs associated with Health Homes are included in the CONTRACTOR's Capitation Rate. The payment shall be an amount based on the CONTRACTOR's Turquoise Care membership enrolled in the Health Home and billed by the Health Home Provider for that month using a PMPM set by HCA. The payment shall be made in accordance with Section 4.20 of this Agreement, Claims Management.
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Health Homes. The Contractor shall administer and fund the State’s Health Home services within the approved Chronic Condition Health Home and Integrated Health Home State Plan Amendments. The Contractor shall provide oversight that includes but not limited to documentation reviews and provider self-assessment reviews to ensure that Health Home Providers are meeting all of the requirements of the Health Home State Plan Amendments, Health Home Manual and Administrative Rules. The Contractor shall provide guidance to Health Home Providers to ensure the requirements of the Health Home State Plan Amendments, Health Home Manual and Administrative Rules are being met. The Contractor shall be responsible for any identified deficiencies. In accordance with federal requirements, the Contractor shall ensure non-duplication of payment for similar services that are offered through another method, such as 1915(c) HCBS waivers, other forms of community-based case management, or value-based purchasing arrangements.
Sample 1
Health Homes. The Contractor shall develop a network of Integrated Health Homes and Chronic Condition Health Homes. The Contractor shall develop strategies to encourage additional participation, particularly in areas of the State where participation has been low. In developing the Integrated Health Home and Chronic Condition Health Home networks, the Contractor shall ensure all providers meet the minimum requirements for participation as defined in the State Plan and the Agency policy. Refer to Section 3.2.9 for additional detail on all health home requirements.
Sample 1
Health Homes. The Contractor shall subcontract with community entities sufficient in quantity and type to provide the intensive services defined in Section 14 of this contract. The Contractor shall provide health home services as part of a qualified health home, or may enter into subcontractor agreements with Health Homes, qualified by the State to deliver health home services for child and adult enrollees with special health care needs, but must have a network of providers sufficient to provide defined services. Subcontractor agreements shall contain elements defined by the State and which may include: 9.7.1 A requirement for subcontractor pre-delegation assessments conducted in accord with delegation requirements. Pre-delegation assessments shall include examination of: 9.7.1.1 The subcontractor’s health information system and its ability to provide timely and efficient population-based and individual enrollee information on quality, cost and utilization-based performance data; 9.7.1.2 If delegated, the adequacy of staff resources, including an assessment of staff skills and abilities to provide care management services to enrollees with special health care needs; 9.7.1.3 If delegated, the tools used by care managers to document care manager enrollee assessments, care plans, and care management described in this Contract; and. 9.7.1.4 Adequacy of a supportive infrastructure beyond the health information system that promotes optimal enrollee outcomes and care experiences that may include, but is not limited to: 9.7.1.4.1 Care management for child and adult enrollees with special health care needs; 9.7.1.4.2 Care teams that facilitate high quality health care services delivery; 9.7.1.4.3 Enrollee reminder systems for primary care and specialist visits; 9.7.1.4.4 Open access scheduling; 9.7.1.4.5 Group visits for enrollees with common disease states such as diabetes, heart disease, asthma, etc.; 9.7.1.4.6 Use of disease registries to track patients individually and as a population; 9.7.1.4.7 Pre-visit planning and outreach to assess enrollee needs and gaps in care and facilitate improved care planning and primary care provider preparation; 9.7.1.4.8 Co-location of behavioral health, dental preventive, visual health or community-based social services; and 9.7.1.4.9 Enhanced access to care provided through alternative hours of care, 24-7 access or nurse call centers that facilitate both appropriate use of services and receipt of evidence-based preventive and illness care. ...
Sample 1
Health Homes. Interpretation of data from the Quality Improvement program.
Sample 1
Health Homes. If an enrollee meets the requirements as defined in the Medicaid State Plan as qualifying for a chronic condition Health Home the MCO must notify the enrollee of the availability of designated Health Homes for his or her condition. If the enrollee chooses to participate, the MCO shall facilitate a referral to the health home. BMS shall provide monthly Health Home enrollment lists to each MCO so that coordination may occur between the MCO and the Health Home provider. If the enrollee is participating in a chronic care Health Home, the Health Home must be notified of any use of emergency services and be notified of any inpatient admission or discharge of a Health Home member that the MCO learns of through its inpatient admission initial authorization and concurrent review processes within 24 hours.
Sample 1

Related to Health Homes

  • Health Services At the time of employment and subject to (b) above, full credit for registered professional nursing experience in a school program shall be given. Full credit for registered professional nursing experience may be given, subject to approval by the Human Resources Division. Non-degree nurses shall be placed on the BA Track of the Teachers Salary Schedule and shall be ineligible for movement to any other track.

  • Healthcare Section 1. Bargaining unit employees with one (1) year or more of service will be provided coverage for the duration of this contract through the “Full Coverage” Team Care Plan (“Team Care MM200”), which includes dental, vision, life, short term disability, medical and prescription drug benefits. Prior to January 1, 2020, bargaining unit employees with less than one (1) year of service will be provided coverage through the “Medical Only” plan. On January 1, 2020, all bargaining unit employees enrolled in the Medical Only plan shall be enrolled in the Full Coverage plan, and the Medical Only plan will eliminated. The rates for 2019 and a further description of the plan and rates are referenced

  • Health Care The Company will reimburse the Executive for the cost of maintaining continuing health coverage under COBRA for a period of no more than 12 months following the date of termination, less the amount the Executive is expected to pay as a regular employee premium for such coverage. Such reimbursements will cease if the Executive becomes eligible for similar coverage under another benefit plan.

  • Behavioral Health Services Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

  • Health Care Operations “Health Care Operations” shall have the same meaning as the term “health care operations” in 45 CFR §164.501.

  • Mental Health Services This agreement covers medically necessary services for the treatment of mental health disorders in a general or specialty hospital or outpatient facilities that are: • reviewed and approved by us; and • licensed under the laws of the State of Rhode Island or by the state in which the facility is located as a general or specialty hospital or outpatient facility. We review network and non-network programs, hospitals and inpatient facilities, and the specific services provided to decide whether a preauthorization, hospital or inpatient facility, or specific services rendered meets our program requirements, content and criteria. If our program content and criteria are not met, the services are not covered under this agreement. Our program content and criteria are defined below.

  • Home Health Care This plan covers the following home care services when provided by a certified home healthcare agency: • nursing services; • services of a home health aide; • visits from a social worker; • medical supplies; and • physical, occupational and speech therapy.

  • Health Examination The University will provide to each member of the bargaining unit a physical examination at the time of employment. Thereafter, an examination will be provided if required by the appropriate accrediting authority, by the University, or by Statute. Employees returning from medical or disability leave must present a note from the treating physician which indicates the date the employee was able to return to duty and certifying the employee's fitness to return to work full duty. The University may, at its own cost and expense, have a physician of its choosing perform a physical examination of the employee to ensure fitness and capability to return to work.

  • Clinical Management for Behavioral Health Services (CMBHS) System 1. request access to CMBHS via the CMBHS Helpline at (000) 000-0000. 2. use the CMBHS time frames specified by System Agency. 3. use System Agency-specified functionality of the CMBHS in its entirety. 4. submit all bills and reports to System Agency through the CMBHS, unless otherwise instructed.

  • Child Care The County will continue to support the concept of non-profit child care facilities similar to the “Kid’s at Work” program established in the Public Works Department.

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