Provision of Care Management Sample Clauses

Provision of Care Management. In accordance with Appendix K, the MCP shall assess new members using the standardized health risk assessment tool within 90 calendar days of enrollment for the purpose of risk stratification and to identify potential needs for care management.
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Provision of Care Management. Requirements for an Interdisciplinary Care Team. Every Enrollee shall have access to and input in the development of an ICT led by a Care Coordinator. The ICT will be person-centered, built on the Enrollee’s specific preferences and needs and with his or her input, delivering services with transparency, individualization, respect, linguistic and cultural competence, and dignity. ICT’s will:
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Provision of Care Management. Contractor shall offer Care Management through a Care Coordinator who participates in an interdisciplinary care team for all medical, behavioral‐health, and Covered Services under service packages I and II, including assessment of the Enrollee’s clinical risks and needs, medication management, and health education on complex clinical conditions, as appropriate to the individual needs and preferences of the Enrollee. Contractor shall ensure that the Care Management services required by this Contract are provided to all Enrollees in NFs. These services may be provided by Nursing Facility Care Coordinators and supplemented by Contractor to fulfil the requirements of this Contract. 5.12.2.1 If Contractor enters into any contract with any entity that also administers the DON or prescreening required under HCBS Waivers, Contractor shall immediately provide the name of that Provider to the Department. 5.12.2.2 Contractor shall coordinate services with the services Enrollee receives from community and social support providers. 5.12.2.3 Contractor shall have the capacity to perform the full range of Care Management prior to implementation, and the State will monitor Contractor’s performance throughout the term of the Contract. 5.12.2.4 Contractor shall implement procedures to coordinate services provided between settings of care, including discharge planning for hospital and institutional stays.
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Provision of Care Management. Contractor shall provide Care Management to all Enrollees that accept or request it, through a Care Coordinator who participates in an Interdisciplinary Care Team (ICT). Care Management includes assessment of the Enrollee’s clinical risks and needs, medication management, and health education on complex clinical conditions, as appropriate to the individual needs and preferences of the Enrollee. 5.12.2.1 If Contractor enters into any contract with any entity that also administers the determination of need (DON) or prescreening required under HCBS Waivers, Contractor shall immediately provide the name of that Provider to the Department. 5.12.2.2 Contractor shall coordinate services with the services the Enrollee receives from community and social support providers. 5.12.2.3 Contractor shall have the capacity to perform the full range of Care Management prior to implementation, and the State will monitor Contractor’s performance throughout the term of the Contract.‌ 5.12.2.4 Contractor shall implement procedures to coordinate services provided between settings of care, including timely discharge planning for hospital and institutional stays. Contractor shall also provide Case management assistance to hospitals in securing timely transfer of patients from non-Network hospitals to contracted facilities. 5.12.2.5 For Enrollees residing in a Nursing Facility, Contractor shall ensure that Care Management services required by this Contract are provided. Nursing Facility Care Coordinators may provide Care Management services that supplement Contractor’s Care Management services.
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Provision of Care Management. 5.11.1.1 Contractor shall offer Care Management through a Care Coordinator who participates in an Interdisciplinary Care Team for all medical, behavioral health and Covered Services under Service Package I and II, including assessment of the Enrollee’s clinical risks and needs, medication management, and health education on complex clinical conditions, as appropriate to the individual needs and preferences of the Enrollee. 5.11.1.2 If Contractor enters into any contract with any entity that also administers the DON or prescreening required under the HCBS Waivers, Contractor shall immediately provide the name of that Provider to the Department. 5.11.1.3 Contractor shall maximize opportunities for an Enrollee’s independence in the community by ensuring the coordination of referrals for other necessary services that are not Covered Services, such as supportive housing and other social services. 5.11.1.4 Contractor shall have the capacity to perform the full range of Care Management prior to implementation of each Service Package as set forth in Section 5.1, and the State will monitor Contractor’s performance throughout the term of the Contract.
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Provision of Care Management. In accordance with Appendix K, the MCP must assure that each member is in a care management arrangement where the MCP (or its delegate) or a patient-centered medical home (PCMH) is the designated primary care management entity. In the event ODM is unable to identify which members are assigned/attributed to a PCMH, the MCP will identify if the member has an existing relationship (i.e., attribution, assignment) with a patient centered medical home (PCMH) and, if not, connect the member to a PCMH, as applicable. There must be a clear delineation of roles and responsibilities between the MCP and other entities (PCMH, community partners, etc.) that are responsible for, or are contributing to, care management in order to assure no duplication of, or gaps in, services. Members under the age of 21 must be initially assigned to the intensive or high risk level until an assessment can be completed to confirm or adjust the initial risk level.
Sample 1Sample 2
Provision of Care Management. In accordance with Appendix K, the MCP must ensure that each member is in a care management arrangement where the MCP (or its delegate) or a Comprehensive Primary Care (CPC) practice is the designated primary care management entity. In the event ODM is unable to identify which members are assigned to a CPC, the MCP will identify if the member has an existing relationship (i.e., attribution, assignment) with a CPC and, if not, connect the member to a CPC, as applicable. There must be a clear delineation of roles and responsibilities between the MCP and other entities (CPC, community partners, etc.) that are responsible for, or are contributing to, care management in order to ensure no duplication or gaps in services. Members under the age of 21 must be initially assigned to the intensive or high risk level until an assessment can be completed to confirm or adjust the initial risk level.
Sample 1
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Provision of Care Management. Contractor shall offer Care Management through a Care Coordinator who participates in an Interdisciplinary Care Team for all medical, behavioral health and Covered Services under Service Package I and II, including assessment of the Enrollee’s clinical risks and needs, medication management, and health education on complex clinical conditions, as appropriate to the individual needs and preferences of the Enrollee.
Sample 1

Related to Provision of Care Management

  • Office Visits (other than Preventive Care Services) This plan covers office and clinic visits to diagnose or treat a sickness or injury. Office visit copayments differ depending on the type of provider you see. This plan covers physician visits in your home if you have an injury or illness that: • confines you to your home; or • requires special transportation; and • because of this injury or illness, you are physically unable to travel to the provider’s

  • Preventive Care This plan covers preventive care as described below. “

  • Vision Care Services For purposes of coordination of benefits, vision care services covered under other plans are not considered an allowable expense, as defined in the Coordination of Benefits and Subrogation in Section 7.

  • Coordination of Care (a) The MA Dual SNP is responsible for coordinating the delivery of all benefits covered by both Medicare and Medicaid for Dual Eligible Members and Other Dual SNP Members who are eligible for LTSS including when benefits are delivered via Medicaid fee-for-service, making reasonable efforts to coordinate Medicare Advantage benefits provided by the MA Dual SNP with LTSS provided through Texas Health and Human Services Commission and the STAR+PLUS HMOs. Coordination of Care must include the following for these members: (1) identify providers of covered Medicaid LTSS in the Texas service areas identified in Attachment A, Proposed MA Product Service Areas; (2) help access needed Medicaid LTSS, to the extent they are available to the member; (3) help coordinate the delivery of Medicaid LTSS and Medicare benefits and services; and (4) provide training to its Network Providers regarding Medicaid LTSS so that they may help members receive needed LTSS that are not covered by Medicare. The MA Dual SNP must inform Network Providers of the Medicare benefits and Medicaid LTSS available to Dual Eligible Members and Other Dual SNP Members. (b) The MA Dual SNP’s Coordination of Care efforts for LTSS may include protocols for working with STAR+PLUS service coordinators or HHSC caseworkers, as well as protocols for reciprocal referral and communication of data and clinical information regarding Dual Eligible Members with the coordinators and caseworkers. (c) MA Dual SNPs that are not designated as HIDE-SNPs by CMS must provide timely notification of all admissions to a hospital and SNF to the STAR+PLUS MCO via a secure file transfer. The file shall be organized and populated in accordance with the template provided by HHSC. For the purposes of this section, timely notification is defined as no later than two business days from which the MA Dual SNP becomes aware that a High Risk Dual Eligible Member has been admitted. If the MA Dual SNP delegates responsibility for information sharing to its contracted hospitals and SNFs, the MA Dual SNP will require its contracted hospitals and SNFs meet the same information sharing requirements on admissions as required of the MA Dual SNP by this Agreement. The MA Dual SNP retains ultimate responsibility for compliance with the information sharing requirements in this Agreement. (d) The MA Dual SNP is responsible for the coordination of both Medicare and Medicaid benefits, regardless of whether a Dual Eligible Member is enrolled with the MA Dual SNP’s companion Health Plan for Medicaid. (e) The MA Dual SNP must provide HHSC with the name of the contact person at the MA Dual SNP who must be responsible for the coordination of care for dual eligible members. The MA Dual SNP must provide the following information to the HHSC designated point of contact referenced in Section 9.06: the MA Dual SNP coordination of care contact person’s name, telephone number, and e-mail address. (f) The MA Dual SNP must also establish a contact person with each STAR+PLUS MCO and provide the same information required in (d) to each STAR+PLUS MCO.

  • Information and Services Required of the Owner The Owner shall provide information with reasonable promptness, regarding requirements for and limitations on the Project, including a written program which shall set forth the Owner’s objectives, constraints, and criteria, including schedule, space requirements and relationships, flexibility and expandability, special equipment, systems, sustainability and site requirements.

  • Information Services Traffic 5.1 For purposes of this Section 5, Voice Information Services and Voice Information Services Traffic refer to switched voice traffic, delivered to information service providers who offer recorded voice announcement information or open vocal discussion programs to the general public. Voice Information Services Traffic does not include any form of Internet Traffic. Voice Information Services Traffic also does not include 555 traffic or similar traffic with AIN service interfaces, which traffic shall be subject to separate arrangements between the Parties. Voice Information services Traffic is not subject to Reciprocal Compensation charges under Section 7 of the Interconnection Attachment. 5.2 If a D&E Customer is served by resold Verizon Telecommunications Service or a Verizon Local Switching UNE, subject to any call blocking feature used by D&E, to the extent reasonably feasible, Verizon will route Voice Information Services Traffic originating from such Service or UNE to the Voice Information Service platform. For such Voice Information Services Traffic, unless D&E has entered into an arrangement with Verizon to xxxx and collect Voice Information Services provider charges from D&E’s Customers, D&E shall pay to Verizon without discount the Voice Information Services provider charges. D&E shall pay Verizon such charges in full regardless of whether or not it collects such charges from its own Customers. 5.3 D&E shall have the option to route Voice Information Services Traffic that originates on its own network to the appropriate Voice Information Services platform(s) connected to Verizon’s network. In the event D&E exercises such option, D&E will establish, at its own expense, a dedicated trunk group to the Verizon Voice Information Service serving switch. This trunk group will be utilized to allow D&E to route Voice Information Services Traffic originated on its network to Verizon. For such Voice Information Services Traffic, unless D&E has entered into an arrangement with Verizon to xxxx and collect Voice Information Services provider charges from D&E’s Customers, D&E shall pay to Verizon without discount the Voice Information Services provider charges. 5.4 D&E shall pay Verizon such charges in full regardless of whether or not it collects charges for such calls from its own Customers. 5.5 For variable rated Voice Information Services Traffic (e.g., NXX 550, 540, 976, 970, 940, as applicable) from D&E Customers served by resold Verizon Telecommunications Services or a Verizon Local Switching Network Element, D&E shall either (a) pay to Verizon without discount the Voice Information Services provider charges, or (b) enter into an arrangement with Verizon to xxxx and collect Voice Information Services provider charges from D&E’s Customers. 5.6 Either Party may request the other Party provide the requesting Party with non discriminatory access to the other party’s information services platform, where such platform exists. If either Party makes such a request, the Parties shall enter into a mutually acceptable written agreement for such access. 5.7 In the event D&E exercises such option, D&E will establish, at its own expense, a dedicated trunk group to the Verizon Information Service serving switch. This trunk group will be utilized to allow D&E to route information services traffic originated on its network to Verizon.

  • Application and Operation Subject Matter No. Clause PART 1 - APPLICATION AND OPERATION Title 1.1 Arrangement 1.2 Objectives 1.3 Commencement date 1.4 Coverage 1.5 Exemptions from coverage 1.6 Relationship with other Industrial instruments 1.7 Definitions 1.8 Commitment of parties 1.9 Transitional arrangements 1.10 PART 2 - TRAINING CONDITIONS Training conditions 2.1 PART 3 - EMPLOYMENT CONDITIONS General 3.1 Part-time apprentices or trainees 3.2 School-based apprentices or trainees 3.3 Alternative employment arrangements 3.4 PART 4 - WAGES AND RELATED MATTERS General 4.1 Entry wage level 4.2 Wage progressions 4.3 Completion of apprenticeship or traineeship 4.4 Part-time apprentices or trainees 4.5 School-based apprentices or trainees 4.6 Areas of employment not covered by an Industrial instrument 4.7 Existing employees 4.8 Adult apprentices and trainees 4.9 Pre-employment, pre-trade, pre-apprenticeship, pre-vocational and other full-time institutional training 4.10 Apprentices and trainees with a disability 4.11 Payment for supervised training 4.12 Supply of tools 4.13 PART 5 -DISPUTE RESOLUTION AND INDUSTRIAL RELATIONS MATTERS Grievance and dispute settlement procedures 5.1 Industrial relations 5.2 SCHEDULES Generic Wage Progression Arrangements for Apprentices and Trainees Schedule Community Services and Health Industries Schedule

  • Vision Care For the duration of this Agreement, the University will continue to provide a vision care plan for members of the bargaining unit and their dependents with benefit levels not less than those in effect as in the predecessor Agreement.

  • Medical Services Plan Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment. The City shall pay one hundred percent (100%) of the premiums required by the plan.

  • Vision Care Plan The County agrees to provide a Vision Care Plan for all employees and dependents. The Plan will be the Vision Service Plan - Plan A with benefits at 12/12/24 month intervals and with twenty dollar ($20.00) deductible for examinations and twenty dollar ($20.00) deductible for materials. The County will fully pay the monthly premium for the employee and dependents and pick up inflationary costs during the term of the Agreement.

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