Common use of Members with SMI Residing in Institutions or At Risk of Institutionalization Clause in Contracts

Members with SMI Residing in Institutions or At Risk of Institutionalization. The Contractor shall participate in transition planning and continued care coordination for Members with SMI who are transitioning from licensed Personal Care Homes, psychiatric hospitals, or other institutional settings to integrated, community based housing. The Contractor shall perform a comprehensive physical and behavioral health assessment designed to support the successful transition to community based housing within fourteen (14) days of the transition. To perform such assessment, the Contractor shall review the Member’s Person- Centered Recovery Plan and level of care determination developed by the provider agency in tandem with Contractor’s routine UM procedures. The Contractor shall provide services that are recommended in the Person-Centered Recovery Plan and that meet medical necessity criteria.