Common use of POPULATIONS SPECIAL HEALTH CARE NEEDS Clause in Contracts

POPULATIONS SPECIAL HEALTH CARE NEEDS. STANDARD FOR COMPLIANCE: MCOs will have satisfactory methods for identifying persons at risk of, or having, chronic disabilities and determining their specific needs in terms of specialist physician referrals, durable medical equipment, medical supplies, home health services, etc. MCOs will have satisfactory systems for coordinating service delivery and, if necessary, procedures to allow continuation of existing relationships with out-of-network provider for course of treatment. SUGGESTED METHODS FOR COMPLIANCE 1. Procedures for requesting standing referrals to specialists and/or specialty centers, specialist physicians to function as PCP, out of plan referrals, and continuation of existing relationships with out-of-network providers for course of treatment 2. Contracts with school-based health centers 3. Linkages with preschool services, child protective agencies, early intervention officials, behavioral health agencies, disability and advocacy organizations, etc. 4. Adequate network of providers and subspecialists (including pediatric providers and sub-specialists) and contractual relationships APPENDIX J October 1, 2004 J-12 with tertiary institutions 5. Procedures for assuring that these populations receive appropriate diagnostic workups on a timely basis 6. Procedures for assuring that these populations receive appropriate access to durable medical equipment on a timely basis 7. Procedures for assuring that these populations receive appropriate allied health professionals (Physical, Occupational and Speech Therapists, Audiologists) on a timely basis 8. State designation as a Well Qualified Plan to serve OMRDD population and look-alikes COMPLIANCE PLAN SUBMISSION 1. A description of arrangements to ensure access to specialty care providers and centers in and out of New York State, standing referrals, specialist physicians to function as PCP, out of plan referrals, and continuation of existing relationships (out-of-plan) for diagnosis and treatment of rare disorders. 2. A description of appropriate service delivery for children with disabilities. This may include a description of methods for interacting with school districts, preschool services, child protective service agencies, early intervention officials, behavioral health, and disability and advocacy organizations and School Based Health Centers. 3. A description of the pediatric provider and sub-specialist network, including contractual relationships with tertiary institutions to meet the health care needs of children with disabilities

POPULATIONS SPECIAL HEALTH CARE NEEDS. STANDARD FOR COMPLIANCE: MCOs will have satisfactory methods for identifying persons at risk of, or having, chronic disabilities and determining their specific needs in terms of specialist physician referrals, durable medical equipment, medical supplies, home health services, etc. MCOs will have satisfactory systems for coordinating service delivery and, if necessary, procedures to allow continuation of existing relationships with out-of-network provider for course of treatment. SUGGESTED METHODS FOR COMPLIANCE 1. Procedures for requesting standing referrals to specialists and/or specialty centers, specialist physicians to function as PCP, out of plan referrals, and continuation of existing relationships with out-of-network providers for course of treatment 2. Contracts with school-based health centers 3. Linkages with preschool services, child protective agencies, early intervention officials, behavioral health agencies, disability and advocacy organizations, etc. 4. Adequate network of providers and subspecialists (including pediatric providers and sub-specialists) and contractual relationships APPENDIX J October 1, 2004 J-12 with tertiary institutions 5. Procedures for assuring that these populations receive appropriate diagnostic workups on a timely basis 6. Procedures for assuring that these populations receive appropriate access to durable medical equipment on a timely basis 7. Procedures for assuring that these populations receive appropriate allied health professionals (Physical, Occupational and Speech Therapists, Audiologists) on a timely basis 8. State designation as a Well Qualified Plan to serve OMRDD population and look-alikes COMPLIANCE PLAN SUBMISSION 1. A description of arrangements to ensure access to specialty care providers and centers in and out of New York State, standing referrals, specialist physicians to function as PCP, out of plan referrals, and continuation of existing relationships (out-of-plan) for diagnosis and treatment of rare disorders. 2. A description of appropriate service delivery for children with disabilities. This may include a description of methods for interacting with school districts, preschool services, child protective service agencies, early intervention officials, behavioral health, and disability and advocacy organizations and School Based Health Centers. 3. A description of the pediatric provider and sub-specialist network, including contractual relationships with tertiary institutions to meet the health care needs of children with disabilities

POPULATIONS SPECIAL HEALTH CARE NEEDS. STANDARD FOR COMPLIANCE: MCOs will have satisfactory methods for identifying persons at risk of, or having, chronic disabilities and determining their specific needs in terms of specialist physician referrals, durable medical equipment, medical supplies, home health services, etc. MCOs will have satisfactory systems for coordinating service delivery and, if necessary, procedures to allow continuation of existing relationships with out-of-network provider for course of treatment. SUGGESTED METHODS FOR COMPLIANCE 1. Procedures for requesting standing referrals to specialists and/or specialty centers, specialist physicians to function as PCP, out of plan referrals, and continuation of existing relationships with out-of-network providers for course of treatment 2. Contracts with school-based health centers 3. Linkages with preschool services, child protective agencies, early intervention officials, behavioral health agencies, disability and advocacy organizations, etc. 4. Adequate network of providers and subspecialists (including pediatric providers and sub-specialists) and contractual relationships APPENDIX J October 1, 2004 J-12 with tertiary institutions 5. Procedures for assuring that these populations receive appropriate diagnostic workups on a timely basis 6. Procedures for assuring that these populations receive appropriate access to durable medical equipment on a timely basis 7. Procedures for assuring that these populations receive appropriate allied health professionals (Physical, Occupational and Speech Therapists, Audiologists) on a timely basis 8. State designation as a Well Qualified Plan to serve OMRDD QMRDD population and look-alikes COMPLIANCE PLAN SUBMISSION 1. A description of arrangements to ensure access to specialty care providers and centers in and out of New York State, standing referrals, specialist physicians to function as PCP, out of plan referrals, and continuation of existing relationships (out-of-plan) for diagnosis and treatment of rare disorders. 2. A description of appropriate service delivery for children with disabilities. This may include a description of methods for interacting with school districts, preschool services, child protective service agencies, early intervention officials, behavioral health, and disability and advocacy organizations and School Based Health Centers. 3. A description of the pediatric provider and sub-specialist network, including contractual relationships with tertiary institutions to meet the health care needs of children with disabilities

POPULATIONS SPECIAL HEALTH CARE NEEDS. STANDARD STANDARD: FOR COMPLIANCE: MCOs will have satisfactory methods for identifying persons at risk of, or having, chronic disabilities and determining their specific needs in terms of specialist physician referrals, durable medical equipment, medical supplies, ; home health services, etc. MCOs will have satisfactory systems for coordinating service delivery and, if necessary, procedures to allow continuation of existing relationships with out-of-network provider for course of treatment. SUGGESTED METHODS FOR COMPLIANCE 1. Procedures for requesting standing referrals to specialists and/or specialty centers, specialist physicians to function as PCP, out of plan referrals, and continuation of existing relationships with out-of-network providers for course of treatment 2. treatment Contracts with school-based health centers 3. centers Linkages with preschool services, child protective agencies, early intervention officials, behavioral health agencies, disability and advocacy organizations, etc. 4. ; Adequate network of providers and subspecialists (including pediatric providers and sub-specialists) and contractual relationships APPENDIX J October OCTOBER 1, 2004 J-12 with tertiary institutions: 5. Procedures Procedures, for assuring that these populations receive appropriate diagnostic workups on a timely basis 6. Procedures for assuring that these populations receive appropriate access to durable medical equipment on a timely basis 7. Procedures for assuring that these populations receive appropriate allied health professionals (Physical, Occupational and Speech Therapists, Audiologists) on a timely basis 8. State designation as a Well Qualified Plan to serve OMRDD population and look-look alikes COMPLIANCE PLAN SUBMISSION 1. CoMplianti Plan Submission A description of arrangements to ensure access to specialty care providers and centers in and out of New York State, standing referrals, specialist physicians to function as PCP, out of plan referrals, and continuation of existing relationships (out-of-plan) for diagnosis and treatment of rare disorders. 2. A description of appropriate service delivery for children with disabilities. This may include a description of methods for interacting with school districts, preschool services, child protective service agencies, early intervention officials, behavioral health, and disability and advocacy organizations and School Based Health Centers. 3. A description of the pediatric provider and sub-specialist network, including contractual relationships with tertiary institutions to meet the health care needs of children with disabilities