Common use of Reimbursed Arrangements with Public Health Entities Clause in Contracts

Reimbursed Arrangements with Public Health Entities. The MCO must make a good faith effort to enter into a Subcontract for Covered Services with Public Health Entities. Possible Covered Services that could be provided by Public Health Entities include, but are not limited to, the following services: 1. Sexually Transmitted Diseases (STDs) services; 2. confidential HIV testing; 3. immunizations; 4. tuberculosis (TB) care; 5. Family Planning services; 6. Texas Health Steps medical checkups, and 7. prenatal services. If the MCO is unable to enter into a contract with Public Health Entities, the MCO must document efforts to contract with Public Health Entities, and make such documentation available to HHSC upon request. MCO Contracts with Public Health Entities must specify the scope of responsibilities of each party, the methodology and agreements regarding billing and reimbursements, reporting responsibilities, Member and Provider educational responsibilities, and the methodology and agreements regarding sharing of confidential medical record information between the Public Health Entity and the MCO or PCP. The MCO must: 1. identify care managers who will be available to assist public health providers and PCPs in efficiently referring Members to the public health providers, specialists, and health-related service providers either within or outside the MCO’s Network; and

Reimbursed Arrangements with Public Health Entities. The MCO must make a good faith effort to enter into a Subcontract for Covered Services with Public Health Entities. Possible Covered Services that could be provided by Public Health Entities include, but are not limited to, the following services: 1. Sexually Transmitted Diseases (STDs) services; 2. confidential HIV testing; 3. immunizations; 4. tuberculosis (TB) care; 5. Family Planning services; 6. Texas Health Steps medical checkups, and 7. prenatal services. If the MCO is unable to enter into a contract with Public Health Entities, the MCO must document efforts to contract with Public Health Entities, and make such documentation available to HHSC upon request. MCO Contracts with Public Health Entities must specify the scope of responsibilities of each party, the methodology and agreements regarding billing and reimbursements, reporting responsibilities, Member and Provider educational responsibilities, and the methodology and agreements regarding sharing of confidential medical record information between the Public Health Entity and the MCO or PCP. The MCO must: 1. identify care managers who will be available to assist public health providers and PCPs in efficiently referring Members to the public health providers, specialists, and health-related service providers either within or outside the MCO’s Network; and