Common use of MCO Protocols Clause in Contracts

MCO Protocols. The Health Home, in the development of a plan of care for a Health Home Participant, shall ensure that such plan of care is in accordance with the MCO’s Participating Provider manual, as applicable to care management and Health Home Services. The Health Home and MCO shall work cooperatively to use in plan resources and address any opportunities for network expansion to best serve Member needs. The Health Home agrees and must require each Health Home Services Provider to agree to adhere to all MCO notification and authorization requirements. Health Home and Health Home Services Providers shall cooperate with quality oversight activities conducted by the MCO. However, nothing herein affects the obligation of a Health Home Services Provider that is also a Participating Provider, for the delivery of Health Home Services, to adhere to and abide by the Participating Provider’s contract with the MCO, the MCO’s Participating Provider manual and all applicable MCO rules. Neither the Health Home nor any Health Home Services Provider shall refer a Member for in-network benefits to any provider or Health Home Services Provider in the Health Home Service Organization that is not otherwise a Participating Provider in the MCO’s Provider Network without the MCO’s prior notice and approval, except in the instance of an Emergency Medical Condition. Health Home shall systematically and timely communicate with the MCO, Health Home Services Providers and Participating Providers about clinical, care coordination and social service referral information regarding Members, as appropriate, and in accordance with legal privacy requirements.

MCO Protocols. The Health Home, in the development of a plan of care for a Health Home Participant, shall ensure that such plan of care is in accordance with the MCO’s Participating Provider manual, as applicable to care management and Health Home Services. The Health Home and MCO shall work cooperatively to use in plan network resources and address any opportunities for network expansion to best serve Member needs. The Health Home agrees and must require each Health Home Services Provider to agree to adhere to all MCO notification and authorization requirements. Health Home and Health Home Services Providers shall cooperate with quality oversight activities conducted by the MCO. However, nothing herein affects the obligation of a Health Home Services Provider that is also a Participating Provider, for the delivery of Health Home Services, to adhere to and abide by the Participating Provider’s contract with the MCO, the MCO’s Participating Provider manual and all applicable MCO rules. Neither the Health Home nor any Health Home Services Provider shall refer a Member for in-network benefits to any provider or Health Home Services Provider in the Health Home Service Organization that is not otherwise a Participating Provider in the MCO’s Provider Network without the MCO’s prior notice and approval, except in the instance of an Emergency Medical Condition. Health Home shall systematically and timely communicate with the MCO, Health Home Services Providers and Participating Providers about clinical, care coordination and social service referral information regarding MembersHealth Home participants, as appropriate, and in accordance with legal privacy requirements.

MCO Protocols. The Health Home, in the development of a plan of care for a Health Home Participant, shall ensure that such plan of care is in accordance with the MCO’s Participating Provider manual, as applicable to care management and Health Home Services. The Health Home and MCO shall work cooperatively to use in plan resources and address any opportunities for network expansion to best serve Member needs. The Health Home agrees and must require each Health Home Services Provider to agree to adhere to all MCO notification and authorization requirements. Health Home and Health Home Services Providers shall cooperate with quality oversight activities conducted by the MCO. However, nothing herein affects the obligation of a Health Home Services Provider that is also a Participating Provider, for the delivery of Health Home Services, to adhere to and abide by the Participating Provider’s contract with the MCO, the MCO’s Participating Provider manual and all applicable MCO rules. Neither the Health Home nor any Health Home Services Provider shall refer a Member for in-in- network benefits to any provider or Health Home Services Provider in the Health Home Service Organization that is not otherwise a Participating Provider in the MCO’s Provider Network without the MCO’s prior notice and approval, except in the instance of an Emergency Medical Condition. Health Home shall systematically and timely communicate with the MCO, Health Home Services Providers and Participating Providers about clinical, care coordination and social service referral information regarding MembersHealth Home Participants, as appropriate, and in accordance with legal privacy requirements.

MCO Protocols. The Health Home, in the development of a plan of care for a Health Home Participant, shall ensure that such plan of care is in accordance with the MCO’s Participating Provider manualmanual and all procedures and protocols regarding service notification, prior authorization, utilization management, patient referrals and the fraud and abuse prevention plan, as applicable to care management and Health Home Services. The Health Home and MCO shall work cooperatively to use in plan resources and address any opportunities for network expansion to best serve Member needsapplicable. The Health Home agrees and must require each Health Home Services Provider to agree to adhere to all MCO referral, notification and authorization requirements. Health Home and Health Home Services Providers shall cooperate with quality oversight activities conducted by the MCO. However, nothing herein affects the obligation of a Health Home Services Provider that is also a Participating Provider, for the delivery of Health Home Services, to adhere to and abide by the Participating Provider’s contract with the MCO, the MCO’s Participating Provider manual and all applicable MCO rules. Neither the Health Home nor any Health Home Services Provider shall refer a Member for in-network benefits to any provider or Health Home Services Provider in the Health Home Service Organization that is not otherwise a Participating Provider in the MCO’s Provider Network without the MCO’s prior notice and approval, except in the instance of an Emergency Medical Condition. Health Home shall systematically and timely communicate with the MCO, Health Home Services Providers and Participating Providers about clinical, care coordination and social service referral information regarding Members, as appropriate, and in accordance with legal privacy requirements.

MCO Protocols. The Health Home, in the development of a plan of care for a Health Home Participant, shall ensure that such plan of care is in accordance with the MCO’s Participating Provider manual, as applicable to care management and Health Home Services. The Health Home and MCO shall work cooperatively to use in plan network resources and address any opportunities for network expansion to best serve Member needs. The Health Home agrees and must require each Health Home Services Provider to agree to adhere to all MCO notification and authorization requirements. Health Home and Health Home Services Providers shall cooperate with quality oversight activities conducted by the MCO. However, nothing herein affects the obligation of a Health Home Services Provider that is also a Participating Provider, for the delivery of Health Home Services, to adhere to and abide by the Participating Provider’s contract with the MCO, the MCO’s Participating Provider manual and all applicable MCO rules. Neither the Health Home nor any Health Home Services Provider shall refer a Member for in-in- network benefits to any provider or Health Home Services Provider in the Health Home Service Organization that is not otherwise a Participating Provider in the MCO’s Provider Network without the MCO’s prior notice and approval, except in the instance of an Emergency Medical Condition. Health Home shall systematically and timely communicate with the MCO, Health Home Services Providers and Participating Providers about clinical, care coordination and social service referral information regarding MembersHealth Home Participants, as appropriate, and in accordance with legal privacy requirements.