Common use of Integration and Coordination of Services Clause in Contracts

Integration and Coordination of Services. 2.5.11.1. The Contractor must promote and support advances in PCPs‘ and other providers‘ capabilities to perform as patient-centered medical homes and/or health homes that provide integrated primary care and behavioral health care. This may take the form of Behavioral Health Services being integrated into a primary care setting or vice versa. The Contractor must support capacity development in at least the Foundational Elements of Primary Care and Behavioral Health Integration described in Appendix L. With regard to the overall integration and coordination of medical, behavioral health and LTSS, beyond supporting ICTs, the Contractor may also use qualified peers and non-medical staff (e.g., Community Health Workers) to support and connect Enrollees with community-based resources. 2.5.11.2. The Contractor shall have written protocols for: 2.5.11.2.1. Generating or receiving referrals or requests for services from Enrollees and for recording and tracking the results of referrals and requests for services from Enrollees; 2.5.11.2.2. Providing or arranging for second opinions, whether in- or out-of-network at no cost to the Enrollee; 2.5.11.2.3. Sharing clinical data and ICT information, including management of medications; 2.5.11.2.4. Determining conditions and circumstances under which specialty services will be provided; 2.5.11.2.5. Tracking and coordination of Enrollee transfers from one setting to another (for example, hospital to home and nursing home to adult day health) and ensuring the provision of necessary new or Continuing Services and supports to minimize unnecessary complications related to care setting transitions; 2.5.11.2.6. Obtaining and sharing individual medical and care planning information among the Enrollee‘s caregivers, and with CMS and EOHHS for quality management and evaluation purposes; and 2.5.11.2.7. Integrating into the ICT care planning process and the ICP, as appropriate, hospice services that may be received by an Enrollee from a hospice provider.

Integration and Coordination of Services. 2.5.11.12.5.12.1. The Contractor must promote and support advances in PCPs‘ ’ and other providers‘ ’ capabilities to perform as patient-centered medical homes and/or health homes that provide integrated primary care and behavioral health care. This may take the form of Behavioral Health Services being integrated into a primary care setting or vice versa. The Contractor must support capacity development in at least the Foundational Elements of Primary Care and Behavioral Health Integration described in Appendix L. With regard to the overall integration and coordination of medical, behavioral health and LTSS, beyond supporting ICTs, the Contractor may also use qualified peers and non-medical staff (e.g., Community Health Workers) to support and connect Enrollees with community-based resources. 2.5.11.22.5.12.2. The Contractor shall have written protocols for: 2.5.11.2.12.5.12.2.1. Generating or receiving referrals or requests for services from Enrollees and for recording and tracking the results of referrals and requests for services from Enrollees; 2.5.11.2.22.5.12.2.2. Providing or arranging for second opinions, whether in- or out-of-network at no cost to the Enrollee; 2.5.11.2.32.5.12.2.3. Sharing clinical data and ICT information, including management of medications; 2.5.11.2.42.5.12.2.4. Determining conditions and circumstances under which specialty services will be provided; 2.5.11.2.52.5.12.2.5. Tracking and coordination of Enrollee transfers from one setting to another (for example, hospital to home and nursing home to adult day health) and ensuring the provision of necessary new or Continuing Services and supports to minimize unnecessary complications related to care setting transitions; 2.5.11.2.62.5.12.2.6. Obtaining and sharing individual medical and care planning information among the Enrollee‘s Enrollee’s caregivers, and with CMS and EOHHS for quality management and evaluation purposes; and 2.5.11.2.72.5.12.2.7. Integrating into the ICT care planning process and the ICP, as appropriate, hospice services that may be received by an Enrollee from a hospice provider.

Integration and Coordination of Services. 2.5.11.1. The Contractor must promote and support advances in PCPs‘ ’ and other providers‘ ’ capabilities to perform as patient-centered medical homes and/or health homes that provide integrated primary care and behavioral health care. This may take the form of Behavioral Health Services being integrated into a primary care setting or vice versa. The Contractor must support capacity development in at least the Foundational Elements of Primary Care and Behavioral Health Integration described in Appendix L. With regard to the overall integration and coordination of medical, behavioral health and LTSS, beyond supporting ICTs, the Contractor may also use qualified peers and non-medical staff (e.g., Community Health Workers) to support and connect Enrollees with community-based resources. 2.5.11.2. The Contractor shall have written protocols for: 2.5.11.2.1. Generating or receiving referrals or requests for services from Enrollees and for recording and tracking the results of referrals and requests for services from Enrollees; 2.5.11.2.2. Providing or arranging for second opinions, whether in- or out-of-network at no cost to the Enrollee; 2.5.11.2.3. Sharing clinical data and ICT information, including management of medications; 2.5.11.2.4. Determining conditions and circumstances under which specialty services will be provided; 2.5.11.2.5. Tracking and coordination of Enrollee transfers from one setting to another (for example, hospital to home and nursing home to adult day health) and ensuring the provision of necessary new or Continuing Services and supports to minimize unnecessary complications related to care setting transitions; 2.5.11.2.6. Obtaining and sharing individual medical and care planning information among the Enrollee‘s Enrollee’s caregivers, and with CMS and EOHHS for quality management and evaluation purposes; and 2.5.11.2.7. Integrating into the ICT care planning process and the ICP, as appropriate, hospice services that may be received by an Enrollee from a hospice provider.