Services for Chronically Homeless Individuals. Subject to the Medical Necessity requirements under 130 CMR 450.204, other Contract requirements, and applicable statutory and regulatory requirements, the Contractor shall provide CSP services as set forth in Appendix B, Exhibit 2 and as directed by EOHHS, to eligible Enrollees as defined in this section. For purposes of this Section 2.5.10., an eligible Enrollee shall be an Enrollee that either (a) received CSP Services for Chronically Homeless Individuals at the time of enrollment, or (b) is Chronically Homeless. The Contractor shall authorize, arrange, coordinate, and provide CSP services as set forth in Appendix B, Exhibit 2 as directed by EOHHS to Enrollees who are Chronically Homeless, which shall include: Assisting in enhancing daily living skills; Providing service coordination and linkages; Assisting with obtaining and maintaining benefits, housing, and healthcare; Developing a crisis plan; Providing prevention and intervention; and Fostering empowerment and recovery, including linkages to peer support and self‑help groups. On the later of January 1, 2022, or the date on which CMS approves the services, subject to the Medical Necessity requirements under 130 CMR 450.204, other Contract requirements, and applicable statutory and regulatory requirements, the Contractor shall provide CSP services as set forth in Appendix B, Exhibit 2 to individuals with Justice Involvement as described in this Section 2.5.11. The Contractor shall authorize, arrange, coordinate, and provide CSP services as set forth in Appendix B, Exhibit 2 to Enrollees with Justice Involvement that consist of intensive, and individualized support delivered face-to-face or via telehealth, as further specified by EOHHS, which shall include: Assisting in enhancing daily living skills; Providing service coordination and linkages; Assisting with obtaining benefits, housing, and healthcare; Developing a safety plan; Providing prevention and intervention; and Fostering empowerment and recovery, including linkages to peer support and self-help groups. For the purpose of this Section 2.5.11, Enrollees with Justice Involvement shall be those individuals released from a correctional institution within one year, or who are under the supervision of the Massachusetts Probation Service or the Massachusetts Parole Board. The Contractor shall, as further directed by XXXXX, with respect to CSP-JI: Actively communicate with CSP-JI providers regarding the provision of CSP-JI services, including coordinating care to ensure that individuals’ needs are met; Ensure that network providers of CSP-JI have demonstrated experience and engage in specialized training; Report to EOHHS about its network providers of CSP-JI in accordance with Appendix N; and Designate a single point of contact for CSP-JI to provide information to CSP-JI providers and EOHHS as further specified by EOHHS. When directed by EOHHS, the Contractor shall maintain agreements with Behavioral Health Supports for Individuals with Justice Involvement providers, as further specified by EOHHS. The Contractor must promote and support advances in PCPs’ and other providers’ capabilities to perform as patient‑centered medical homes and/or health homes that provide integrated primary care and behavioral health care. This may take the form of Behavioral Health Services being integrated into a primary care setting or vice versa. The Contractor must support capacity development in at least the Foundational Elements of Primary Care and Behavioral Health Integration described in Appendix L. With regard to the overall integration and coordination of medical, behavioral health and LTSS, beyond supporting ICTs, the Contractor may also use qualified peers and non‑medical staff (e.g., Community Health Workers) to support and connect Enrollees with community‑based resources. The Contractor shall have written protocols for: Generating or receiving referrals or requests for services from Enrollees and for recording and tracking the results of referrals and requests for services from Enrollees; Providing or arranging for second opinions, whether in‑ or out‑of‑network at no cost to the Enrollee; Sharing clinical data and ICT information, including management of medications; Determining conditions and circumstances under which specialty services will be provided; Tracking and coordination of Enrollee transfers from one setting to another (for example, hospital to home and nursing home to adult day health) and ensuring the provision of necessary new or Continuing Services and supports to minimize unnecessary complications related to care setting transitions; Obtaining and sharing individual medical and care planning information among the Enrollee’s caregivers, and with CMS and EOHHS for quality management and evaluation purposes; and Integrating into the ICT care planning process and the ICP, as appropriate, hospice services that may be received by an Enrollee from a hospice provider.
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Samples: Three Way Contract for Capitated Model, Three Way Contract for Capitated Model, Three Way Contract for Capitated Model
Services for Chronically Homeless Individuals. Subject to the Medical Necessity requirements under 130 CMR 450.204, other Contract requirements, and applicable statutory and regulatory requirements, the Contractor shall provide CSP services as set forth in Appendix B, Exhibit 2 and as directed by EOHHS, to eligible Enrollees as defined in this section. For purposes of this Section 2.5.10., an eligible Enrollee shall be an Enrollee that either (a) received CSP Services for Chronically Homeless Individuals at the time of enrollment, or (b) is Chronically Homeless. The Contractor shall authorize, arrange, coordinate, and provide CSP services as set forth in Appendix B, Exhibit 2 as directed by EOHHS to Enrollees who are Chronically Homeless, which shall include: Assisting in enhancing daily living skills; Providing service coordination and linkages; Assisting with obtaining and maintaining benefits, housing, and healthcare; Developing a crisis plan; Providing prevention and intervention; and Fostering empowerment and recovery, including linkages to peer support and self‑help groups. On the later of January 1, 2022, or the date on which CMS approves the services, subject to the Medical Necessity requirements under 130 CMR 450.204, other Contract requirements, and applicable statutory and regulatory requirements, the Contractor shall provide CSP services as set forth in Appendix B, Exhibit 2 to individuals with Justice Involvement as described in this Section 2.5.11. The Contractor shall authorize, arrange, coordinate, and provide CSP services as set forth in Appendix B, Exhibit 2 to Enrollees with Justice Involvement that consist of intensive, and individualized support delivered face-to-face or via telehealth, as further specified by EOHHS, which shall include: Assisting in enhancing daily living skills; Providing service coordination and linkages; Assisting with obtaining benefits, housing, and healthcare; Developing a safety plan; Providing prevention and intervention; and Fostering empowerment and recovery, including linkages to peer support and self-help groups. For the purpose of this Section 2.5.11, Enrollees with Justice Involvement shall be those individuals released from a correctional institution within one year, or who are under the supervision of the Massachusetts Probation Service or the Massachusetts Parole Board. The Contractor shall, as further directed by XXXXX, with respect to CSP-JI: Actively communicate with CSP-JI providers regarding the provision of CSP-JI services, including coordinating care to ensure that individuals’ needs are met; Ensure that network providers of CSP-JI have demonstrated experience and engage in specialized training; Report to EOHHS about its network providers of CSP-JI in accordance with Appendix N; and Designate a single point of contact for CSP-JI to provide information to CSP-JI providers and EOHHS as further specified by EOHHS. When directed by EOHHS, the Contractor shall maintain agreements with Behavioral Health Supports for Individuals with Justice Involvement providers, as further specified by EOHHS. The Contractor must promote and support advances in PCPs’ and other providers’ capabilities to perform as patient‑centered medical homes and/or health homes that provide integrated primary care and behavioral health care. This may take the form of Behavioral Health Services being integrated into a primary care setting or vice versa. The Contractor must support capacity development in at least the Foundational Elements of Primary Care and Behavioral Health Integration described in Appendix L. With regard to the overall integration and coordination of medical, behavioral health and LTSS, beyond supporting ICTs, the Contractor may also use qualified peers and non‑medical staff (e.g., Community Health Workers) to support and connect Enrollees with community‑based resources. The Contractor shall have written protocols for: Generating or receiving referrals or requests for services from Enrollees and for recording and tracking the results of referrals and requests for services from Enrollees; Providing or arranging for second opinions, whether in‑ or out‑of‑network at no cost to the Enrollee; Sharing clinical data and ICT information, including management of medications; Determining conditions and circumstances under which specialty services will be provided; Tracking and coordination of Enrollee transfers from one setting to another (for example, hospital to home and nursing home to adult day health) and ensuring the provision of necessary new or Continuing Services and supports to minimize unnecessary complications related to care setting transitions; Obtaining and sharing individual medical and care planning information among the Enrollee’s caregivers, and with CMS and EOHHS for quality management and evaluation purposes; and Integrating into the ICT care planning process and the ICP, as appropriate, hospice services that may be received by an Enrollee from a hospice provider.
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