Services for All Members. All members of Partnership and PACE, who are at the nursing home level of care, shall receive integrated acute, primary and long-term care services pursuant to this contract, state and federal regulations.
a. The MCO shall promptly provide or arrange for the provision of all health and long-term care services in the benefit package, consistent with the member-centered plan described in Article V.C., Assessment and Member-Centered Planning Process, page 53.
b. Coverage of services identified in each individual member’s MCP must be consistent with the definition of “Services Necessary to Support Outcomes” in Article I, Definitions, beginning on page 3.
c. Partnership and PACE services include all the following:
i. The home and community-based waiver services defined in Addendum VIII.A., page 298;
ii. All Medicaid State Plan Services identified in Addendum VIII.C., page 326;
iii. Any cost-effective health care services the MCO substitutes for a service in the Medicaid State Plan identified in Addendum VIII.C., page 326; and
iv. Medicare Part A/B deductibles, co-payments and co-insurance.
Services for All Members. A. Health Education
1) Contractor shall implement and maintain a health education system that includes programs, services, functions, and resources necessary to provide health education, health promotion and patient education for all Members.
2) Contractor shall ensure administrative oversight of the health education system by a qualified full-time health educator.
3) Contractor shall provide health education programs and services at no charge to Members directly and/or through Subcontracts or other formal agreements with providers that have expertise in delivering health education services to the Member population.
4) Contractor shall ensure the organized delivery of health education programs using educational strategies and methods that are appropriate for Members and effective in achieving behavioral change for improved health.
5) Contractor shall ensure that health education materials are written at the sixth grade reading level and are culturally and linguistically appropriate for the intended audience.
6) Contractor shall maintain a health education system that provides educational interventions addressing the following health categories and topics:
a) Appropriate use of health care services – managed health care; preventive and primary health care; obstetrical care; health education services; and, complementary and alternative care.
b) Risk-reduction and healthy lifestyles – tobacco use and cessation; alcohol and drug use; injury prevention; prevention of sexually transmitted diseases; HIV and unintended pregnancy; nutrition, weight control, and physical activity; and, parenting.
c) Self-care and management of health conditions – pregnancy; asthma; diabetes; and, hypertension.
7) Contractor shall ensure that Members receive point of service education as part of preventive and primary health care visits. Contractor shall provide education, training, and program resources to assist contracting medical providers in the delivery of health education services for Members.
8) Contractor shall maintain health education policies and procedures, and standards and guidelines; conduct appropriate levels of program evaluation; and, monitor performance of providers that are contracted to deliver health education services to ensure effectiveness.
9) Contractor shall periodically review the health education system to ensure appropriate allocation of health education resources, and maintain documentation that demonstrates effective implementation of the health educa...
Services for All Members. All members of PACE shall receive integrated acute, primary and long-term care services pursuant to this contract, state and federal regulations. The PO shall promptly provide or arrange for the provision of all health and long-term care services, consistent with the member-centered plan described in Article V.C., Assessment and Member-Centered Planning Process. Coverage of services identified in each individual member’s MCP must be consistent with the definition of “Services Necessary to Support Outcomes” in Article I, Definitions. PACE services include all the following, regardless of the source of payment: All Medicare-covered items and services; The home and community-based waiver services defined in AddendumVII.A.; All Medicaid State Plan Services identified in Addendum VIII.B.; Any cost-effective health care services the PO substitutes for a service in the Medicaid State Plan identified in Addendum VIII.B.; and Other services determined necessary by the interdisciplinary team to improve and maintain the participant’s overall health status. Provision of Abortions, Hysterectomies and Sterilizations The PO shall comply with the following state and federal compliance requirements for the services listed below: Abortions must comply with the requirements of Wis. Stat. § 20.927 and with 42 C.F.R. § 441 Subpart E - Abortions. Hysterectomies and sterilizations must comply with 42 C.F.R. § 441 Subpart F - Sterilizations. Sanctions in the amount of ten thousand dollars ($10,000.00) may be imposed for non-compliance with the above compliance requirements. The PO must abide by Wis. Stat. § 609.30. The PO must comply with all record keeping and retention requirements for abortions, hysterectomies and sterilizations.
Services for All Members. A. Health Education
1) Contractor shall implement and maintain a health education system that provides the organized programs, services, functions, and resources necessary to deliver health education, health promotion and patient education to assist Members improve their health and manage illness.
2) Contractor shall ensure administrative oversight, direction, management, and supervision of the health education system by a qualified, full-time health educator. Contractor shall maintain the organization and staffing to ensure successful implementation and maintenance of an effective health education system. Health education program activities must be coordinated and integrated with the Contractor’s overall health care and quality improvement plan.
3) Contractor shall conduct a Health Education, Cultural and Linguistic Group Needs Assessment (GNA) to identify the health education, cultural and linguistic needs of Members and utilize the findings for continuous development and improvement of contractually required health education programs and services. Contractor shall use multiple, reliable data sources, methodologies, techniques, and tools to conduct the GNA. A GNA shall be conducted for the entire Service Area and shall be completed within 12 months from the commencement of operations and completed every five (5) years thereafter. For contracts existing at the time this provision becomes effective, the next GNA will be required at a time within this five (5) year period, to be determined by DHCS.
a) Contractor shall submit a GNA Summary Report to DHCS at the completion of each GNA. The Summary Report shall include: objectives; methodology; data sources; survey instruments; findings and conclusions; program and policy implications; and references. Findings and conclusions must include the following information for Members: demographic profile; related health risks, problems and conditions; related knowledge, attitudes and practices including cultural beliefs and practices; perceived health education needs including learning needs; preferred methods of learning and literacy level; and culturally competent community resources.
b) Contractor shall prepare a GNA Annual Update (every year) and shall maintain, and have available for DHCS review. The GNA Annual Update shall include any updated objectives, methodology, data sources, survey instruments, findings and conclusions; program and policy implications, and references. Findings and conclusions must include ...
Services for All Members. All members of PACE shall receive integrated acute, primary and long-term care services pursuant to this contract, state and federal regulations.
a. The PO shall promptly provide or arrange for the provision of all health and long-term care services, consistent with the member-centered plan
Services for All Members. All members of PACE shall receive integrated acute, primary and long-term care services pursuant to this contract, state and federal regulations.
a. The PO shall promptly provide or arrange for the provision of all health and long-term care services, consistent with the member-centered plan described in Article V.C., Assessment and Member-Centered Planning Process.
b. Coverage of services identified in each individual member’s MCP must be consistent with the definition of “Services Necessary to Support Outcomes” in Article I, Definitions.
x. XXXX services include all the following:
i. All Medicare-covered items and services;
ii. The home and community-based waiver services defined in AddendumVII.A.;
iii. All Medicaid State Plan Services identified in Addendum VIII.B.;
iv. Any cost-effective health care services the PO substitutes for a service in the Medicaid State Plan identified in Addendum VIII.B.; and
Services for All Members
