Common use of Other Professional and Support Disciplines Clause in Contracts

Other Professional and Support Disciplines. Consistent with the Enrollee’s ICP, the Contractor may employ or contract with Community Health Workers under the supervision of the ICT to provide: Wellness coaching to engage the Enrollee in prevention activities such as smoking cessation, exercise, diet, and obtaining health screenings; Evidence‑based practices and techniques for chronic disease self‑management; Qualified peer support for Enrollees with mental health and substance use disorders to assist such Enrollees in their recovery, and for Enrollees with physical disabilities to assist such Enrollees in the pursuit of independent living; and Community supports for newly housed Enrollees who have experienced chronic homelessness. Community Health Workers must be available and appropriate for the populations served, such as for Enrollees who are Deaf or hard of hearing. Coordinating Services with Federal, State, and Community Agencies General Agencies. The Contractor must implement a systemic process for coordinating care and creating linkages between Enrollees and organizations that provide services not covered under the Demonstration, including but not limited to: State agencies (e.g. the Department of Developmental Services (DDS), Department of Mental Health (DMH), Department of Public Health (DPH) and DPH’s Bureau of Substance Addiction Services (DPH/BSAS), Massachusetts Commission for the Blind (MCB), Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH), Massachusetts Rehabilitation Commission, and the Executive Office of Elder Affairs (EOEA)); Social service agencies; Community‑based mental health and substance use disorder programs; Consumer, civic, and religious organizations; and Federal agencies (e.g. the Department of Veterans Affairs, Housing and Urban Development, and the Social Security Administration). Requirements ‑‑ The systematic process and associated linkages must provide for: Sharing information and generating, receiving, and tracking referrals; Obtaining and recording consent from Enrollees to share individual Enrollee medical information where necessary; and Ongoing coordination efforts (for example, regularly scheduled meetings, newsletters, and jointly community‑based projects). Department of Mental Health (DMH) ‑‑ The Contractor shall ensure that services are provided to Enrollees with DMH affiliation as follows: Ensure that Covered Services are delivered to all Enrollees; Ensure that the ICT communicates with the DMH caseworker(s) assigned to Enrollees and informs them of the services provided through the Contractor’s plan; Ensure that for all DMH clients, a release of information is requested to be used to inform the agency of the Enrollee’s current status; Ensure that for all DMH clients, the ICP specifies all Behavioral Health Services required during any acute Behavioral Health Inpatient Services stay, identifies discharge plans and, when appropriate, indicates the need for DMH Community‑Based Services or continuing inpatient psychiatric care as part of the ICP; and Designate a DMH liaison to work with MassHealth and DMH. Such liaison shall: Have at least two (2) years of care management experience, at least one (1) of which must be working with individuals in need of significant Behavioral Health Services; Actively participate in the planning and management of service for individuals who are clients of DMH. This shall include, but not be limited to: Establishing and maintaining contact with designated DMH case managers, as identified by DMH, and assisting MassHealth and DMH in resolving any problems or issues that may arise with a DMH‑affiliated Enrollee; Upon request of DMH, participating in regional informational and educational meetings with DMH staff and, as directed by DMH, family members and peer support workers; As requested by DMH, providing advice and assistance to regional directors or case managers on individual cases regarding Covered Services and coordinating non‑Covered Services; If requested by DMH, working with providers of twenty‑four (24) hour inpatient or diversionary services to coordinate discharge planning; As requested by XxxxXxxxxx, actively participating in any joint meetings or workgroups with MassHealth or other EOHHS agencies; Performing any functions to assist the Contractor in complying with the requirements of Section 2.5.9.1; and Assisting DMH caseworkers with obtaining appointments in compliance with Section 2.9.2. Department of Developmental Services (DDS) The Contractor shall ensure that services are provided to Enrollees with DDS affiliation as follows: The Contractor shall: Ensure that Covered Services are delivered to all Enrollees; Ensure that the ICT communicates with the DDS caseworker(s) assigned to Enrollees and inform them of the services provided through the Contractor’s Plan; Designate a DDS liaison to work with MassHealth and DDS. Such liaison shall: Have at least two (2) years of care management experience, at least one of which must be working with individuals in need of services related to developmental or intellectual disability; Actively participate in the planning and management of services for individuals who are clients of DDS. This shall include, but not be limited to: Establishing and maintaining contact with designated DDS case managers, as identified by DDS, and assisting MassHealth and DDS in resolving any problems or issues that may arise with a DDS‑affiliated Enrollee; Upon request of DDS, participating in regional informational and educational meetings with DDS staff; As requested by DDS, providing advice and assistance to regional directors or case managers on individual cases regarding Covered Services and coordinating non‑Covered Services; If requested by DDS, working with providers of twenty‑four (24) hour inpatient or diversionary services to coordinate discharge planning; As requested by XxxxXxxxxx, actively participating in any joint meetings or workgroups with MassHealth or other EOHHS agencies; Performing any functions to assist the Contractor in complying with the requirements of Section 2.5.9.1; and Assisting DDS caseworkers with obtaining appointments in compliance with Section 2.9.2. The Contractor shall designate a liaison to work with designated EOHHS staff and the Commissioners of each of the following agencies within EOHHS: DDS, DMH, Department of Public Health and DPH’s Bureau of Substance Addiction Services (DPH/BSAS), Massachusetts Rehabilitation Commission (MRC), Massachusetts Commission for the Blind (MCB), Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH) and the Executive Office of Elder Affairs (EOEA). Such liaison shall: Have at least two (2) years of care management experience, at least one (1) of which must be working with adults who: Have developmental disabilities; Have severe physical disabilities; Are Deaf or hard of hearing; or Are blind or visually impaired. Establish and maintain contact with designated EOHHS staff and assist in the resolution of any problems or issues that may arise with an Enrollee affiliated with each such agency. As requested by EOHHS, participate in regional informational and educational meetings with EOHHS staff and, as directed by XXXXX, individuals, caregivers, or other family member(s); As requested by EOHHS, provide advice and assistance to DDS, DMH, DPH, MRC, MCB, MCDHH, and other State agencies as may be needed, on individual cases regarding Covered Services and coordinating non‑Covered Services provided by State agencies other than MassHealth; and As requested by EOHHS, actively participate in any joint meetings or workgroups with EOHHS agencies. As directed by EOHHS, the Contractor shall participate in any EOHHS efforts related to the development of policies or programs, as well as measurement, analytics, and reporting relating to such policies and programs, that support access, coordination, and continuity of behavioral health care, including substance use treatment related to the opioid epidemic and which facilitate access to appropriate behavioral health services and timely discharge from the emergency department. Such policies or programs may include, but are not limited to, the development of: Specialized inpatient services; New diversionary and urgent levels of care; Expanded SUD treatment services; and Services and supports tailored to populations with significant behavioral health needs, including justice involved and homeless populations; The Contractor shall support Enrollee access to, and work with, the Ombudsman to address Enrollee and Eligible Beneficiary requests for information, issues, or concerns related to One Care, including: Educating Enrollees about the availability of Ombudsman services: On the Contractor’s website; When Enrollees receive the Member Welcome package; At the time of the annual Comprehensive Assessment; and When Enrollees – or their family members or representatives – contact One Care plan staff, including member services and provider staff, with a concern, Complaint, Grievance, or Appeal; Communicating and cooperating with Ombudsman staff as needed for them to investigate and resolve Enrollee or Eligible Beneficiary requests for information, issues, or concerns related to One Care, including: Designating a staff person as the Contractor’s Ombudsman liaison, who shall liaise with the Ombudsman to resolve issues raised by Enrollees; Providing Ombudsman staff with access to records needed to investigate and resolve Enrollee Complaints (with the Enrollee’s approval); and Ensuring ongoing communication and cooperation of Plan staff with Ombudsman staff in working to investigate and resolve Enrollee Complaints, including updates on progress made towards resolution, until such time as the Complaints have been resolved.

Other Professional and Support Disciplines. Consistent with the Enrollee’s ICP, the Contractor may employ or contract with Community Health Workers under the supervision of the ICT to provide: Wellness coaching to engage the Enrollee in prevention activities such as smoking cessation, exercise, diet, and obtaining health screenings; Evidence‑based practices and techniques for chronic disease self‑management; Qualified peer support for Enrollees with mental health and substance use disorders to assist such Enrollees in their recovery, and for Enrollees with physical disabilities to assist such Enrollees in the pursuit of independent living; and Community supports for newly housed Enrollees who have experienced chronic homelessness. Community Health Workers must be available and appropriate for the populations served, such as for Enrollees who are Deaf or hard of hearing. Coordinating Services with Federal, State, and Community Agencies General Agencies. The Contractor must implement a systemic process for coordinating care and creating linkages between Enrollees and organizations that provide services not covered under the Demonstration, including but not limited to: State agencies (e.g. the Department of Developmental Services (DDS), Department of Mental Health (DMH), Department of Public Health (DPH) and DPH’s Bureau of Substance Addiction Services (DPH/BSAS), Massachusetts Commission for the Blind (MCB), Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH), Massachusetts Rehabilitation Commission, and the Executive Office of Elder Affairs (EOEA)); Social service agencies; Community‑based mental health and substance use disorder programs; Consumer, civic, and religious organizations; and Federal agencies (e.g. the Department of Veterans Affairs, Housing and Urban Development, and the Social Security Administration). Requirements ‑‑ The systematic process and associated linkages must provide for: Sharing information and generating, receiving, and tracking referrals; Obtaining and recording consent from Enrollees to share individual Enrollee medical information where necessary; and Ongoing coordination efforts (for example, regularly scheduled meetings, newsletters, and jointly community‑based projects). Department of Mental Health (DMH) ‑‑ The Contractor shall ensure that services are provided to Enrollees with DMH affiliation as follows: Ensure that Covered Services are delivered to all Enrollees; Ensure that the ICT communicates with the DMH caseworker(s) assigned to Enrollees and informs them of the services provided through the Contractor’s plan; Ensure that for all DMH clients, a release of information is requested to be used to inform the agency of the Enrollee’s current status; Ensure that for all DMH clients, the ICP specifies all Behavioral Health Services required during any acute Behavioral Health Inpatient Services stay, identifies discharge plans and, when appropriate, indicates the need for DMH Community‑Based Services or continuing inpatient psychiatric care as part of the ICP; and Designate a DMH liaison to work with MassHealth and DMH. Such liaison shall: Have at least two (2) years of care management experience, at least one (1) of which must be working with individuals in need of significant Behavioral Health Services; Actively participate in the planning and management of service for individuals who are clients of DMH. This shall include, but not be limited to: Establishing and maintaining contact with designated DMH case managers, as identified by DMH, and assisting MassHealth and DMH in resolving any problems or issues that may arise with a DMH‑affiliated Enrollee; Upon request of DMH, participating in regional informational and educational meetings with DMH staff and, as directed by DMH, family members and peer support workers; As requested by DMH, providing advice and assistance to regional directors or case managers on individual cases regarding Covered Services and coordinating non‑Covered Services; If requested by DMH, working with providers of twenty‑four (24) hour inpatient or diversionary services to coordinate discharge planning; As requested by XxxxXxxxxxMassHealth, actively participating in any joint meetings or workgroups with MassHealth or other EOHHS agencies; Performing any functions to assist the Contractor in complying with the requirements of Section 2.5.9.1; and Assisting DMH caseworkers with obtaining appointments in compliance with Section 2.9.2. Department of Developmental Services (DDS) The Contractor shall ensure that services are provided to Enrollees with DDS affiliation as follows: The Contractor shall: Ensure that Covered Services are delivered to all Enrollees; Ensure that the ICT communicates with the DDS caseworker(s) assigned to Enrollees and inform them of the services provided through the Contractor’s Plan; Designate a DDS liaison to work with MassHealth and DDS. Such liaison shall: Have at least two (2) years of care management experience, at least one of which must be working with individuals in need of services related to developmental or intellectual disability; Actively participate in the planning and management of services for individuals who are clients of DDS. This shall include, but not be limited to: Establishing and maintaining contact with designated DDS case managers, as identified by DDS, and assisting MassHealth and DDS in resolving any problems or issues that may arise with a DDS‑affiliated Enrollee; Upon request of DDS, participating in regional informational and educational meetings with DDS staff; As requested by DDS, providing advice and assistance to regional directors or case managers on individual cases regarding Covered Services and coordinating non‑Covered Services; If requested by DDS, working with providers of twenty‑four (24) hour inpatient or diversionary services to coordinate discharge planning; As requested by XxxxXxxxxxMassHealth, actively participating in any joint meetings or workgroups with MassHealth or other EOHHS agencies; Performing any functions to assist the Contractor in complying with the requirements of Section 2.5.9.1; and Assisting DDS caseworkers with obtaining appointments in compliance with Section 2.9.2. The Contractor shall designate a liaison to work with designated EOHHS staff and the Commissioners of each of the following agencies within EOHHS: DDS, DMH, Department of Public Health and DPH’s Bureau of Substance Addiction Services (DPH/BSAS), Massachusetts Rehabilitation Commission (MRC), Massachusetts Commission for the Blind (MCB), Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH) and the Executive Office of Elder Affairs (EOEA). Such liaison shall: Have at least two (2) years of care management experience, at least one (1) of which must be working with adults who: Have developmental disabilities; Have severe physical disabilities; Are Deaf or hard of hearing; or Are blind or visually impaired. ; Establish and maintain contact with designated EOHHS staff and assist in the resolution of any problems or issues that may arise with an Enrollee affiliated with each such agency. As requested by EOHHS, participate in regional informational and educational meetings with EOHHS staff and, as directed by XXXXXEOHHS, individuals, caregivers, or other family member(s); As requested by EOHHS, provide advice and assistance to DDS, DMH, DPH, MRC, MCB, MCDHH, and other State agencies as may be needed, on individual cases regarding Covered Services and coordinating non‑Covered Services provided by State agencies other than MassHealth; and As requested by EOHHS, actively participate in any joint meetings or workgroups with EOHHS agencies. As directed by EOHHS, the Contractor shall participate in any EOHHS efforts related to the development of policies or programs, as well as measurement, analytics, and reporting relating to such policies and programs, that support access, coordination, and continuity of behavioral health care, including substance use treatment related to the opioid epidemic and which facilitate access to appropriate behavioral health services and timely discharge from the emergency department. Such policies or programs may include, but are not limited to, the development of: Specialized inpatient services; New diversionary and urgent levels of care; Expanded SUD treatment services; and Services and supports tailored to populations with significant behavioral health needs, including justice involved and homeless populations; The Contractor shall support Enrollee access to, and work with, the Ombudsman to address Enrollee and Eligible Beneficiary requests for information, issues, or concerns related to One Care, including: Educating Enrollees about the availability of Ombudsman services: On the Contractor’s website; When Enrollees receive the Member Welcome package; At the time of the annual Comprehensive Assessment; and When Enrollees – or their family members or representatives – contact One Care plan staff, including member services and provider staff, with a concern, Complaint, Grievance, or Appeal; Communicating and cooperating with Ombudsman staff as needed for them to investigate and resolve Enrollee or Eligible Beneficiary requests for information, issues, or concerns related to One Care, including: Designating a staff person as the Contractor’s Ombudsman liaison, who shall liaise with the Ombudsman to resolve issues raised by Enrollees; Providing Ombudsman staff with access to records needed to investigate and resolve Enrollee Complaints (with the Enrollee’s approval); and Ensuring ongoing communication and cooperation of Plan staff with Ombudsman staff in working to investigate and resolve Enrollee Complaints, including updates on progress made towards resolution, until such time as the Complaints have been resolved.