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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Samples: Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement
Health Homes. The CONTRACTOR shall comply and cooperate with HCAHSD’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 HSD 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 HSD 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 HCAHSD. The payment shall be made in accordance with Section 4.20 of this Agreement, Claims Management.
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