Transition of Care Process Sample Clauses

Transition of Care Process. The FIDA Plan will manage transitions of care and continuity of care for Participants moving from an institutional setting to a community living arrangement. The FIDA Plan’s process for facilitating continuity of care will include ensuring that both the IDT and the FIDA Plan do the following:
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Transition of Care Process. The ICDS Plan must allow Beneficiaries to maintain current Providers and service levels at the time of Enrollment as described in Table 1-A below. If a Beneficiary enrolls in an ICDS plan for Medicaid benefits prior to enrolling in the Demonstration, then the transition timeframe for Medicaid services begins on the Beneficiary’s Medicaid enrollment effective date. The timeframes for Medicaid services in Table 1-A include the Medicaid enrollment period immediately preceding Enrollment in the Demonstration. 2.5.4.1.1. During the transition period, change from the existing provider can only occur in the following circumstances: 2.5.4.1.1.1. Beneficiary requests a change; 2.5.4.1.1.2. The Provider chooses to discontinue providing services to a Beneficiary as currently allowed by Medicare or Medicaid; or 2.5.4.1.1.3. The ICDS Plan, CMS, or the ODM identified Provider performance issues that affect a Beneficiary’s health and welfare.
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Transition of Care Process. The Contractor will manage transition of care and continuity of care for new Enrollees, Enrollees moving from an institutional setting to a community living arrangement, and Enrollees moving from a hospital back to the Enrollee’s home or Nursing Facility. The Contractor’s process for facilitating continuity of care will include: 2.5.3.1.1 Identification of Enrollees needing transition of care. 2.5.3.1.2 Communication with entities involved in Enrollees’ transition. 2.5.3.1.3 Making accommodations so that all community supports, including housing, are in place prior to the Enrollee’s move and that Providers are fully knowledgeable and prepared to support the Enrollee, including interface and coordination with and among social supports, clinical services and LTSS.
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Transition of Care Process. The ICDS Plan must allow Beneficiaries to maintain current Providers and service levels at the time of Enrollment as described in Table 1- A below. If a Beneficiary enrolls in an ICDS plan for Medicaid benefits prior to enrolling in the demonstration, then the transition timeframe for Medicaid services begins on the beneficiary’s Medicaid enrollment effective date. The timeframes for Medicaid services in Table 1-A include the Medicaid enrollment period immediately preceding enrollment in the demonstration.
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Transition of Care Process. The Contractor will manage transition of care and continuity of care for new Enrollees, Enrollees moving from an institutional setting to a community living arrangement, and Enrollees moving from a hospital back to the Enrollee’s home or NF. The Contractor’s process for facilitating continuity of care will include: 2.5.4.1.1 Identification of Enrollees needing transition of care. 2.5.4.1.2 Communication with entities involved in Enrollees’ transition. 2.5.4.1.3 Making accommodations so that all community supports, including housing, are in place prior to the Enrollee’s move and that Providers are fully knowledgeable and prepared to support the Enrollee, including interface and coordination with and among social supports, clinical services and LTSS. 2.5.4.1.4 Environmental adaptations and equipment and technology the Enrollee needs for a successful care setting transition. 2.5.4.1.5 Stabilization and provision of uninterrupted access to Covered Services for the Enrollee. 2.5.4.1.6 Assessment of Enrollees’ ongoing care needs. 2.5.4.1.7 Monitoring of continuity and quality of care, and services provided.
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Transition of Care Process. Contractor will manage Transition of Care and Continuity of Care for new Enrollees and for Enrollees moving from an institutional setting to a community setting. Contractor’s process for facilitating Continuity of Care will include: 5.18.1.1 identification of Enrollees deemed critical for Continuity of Care; 5.18.1.2 communication with entities involved in Enrollees’ transition; 5.18.1.3 stabilization and provision of uninterrupted access to Covered Services; 5.18.1.4 assessment of Enrollees’ ongoing care needs; 5.18.1.5 monitoring of continuity and quality of care, and services provided; and 5.18.1.6 medication reconciliation.
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Transition of Care Process. Contractor will manage transition of care and continuity of care for new Enrollees and for Enrollees moving from an institutional setting to a community living arrangement. Contractor’s process for facilitating continuity of care will include: 5.15.1.1 Identification of Enrollees deemed critical for continuity of care. 5.15.1.2 Communication with entities involved in Enrollees’ transition. 5.15.1.3 Stabilization and provision of uninterrupted access to Covered Services. 5.15.1.4 Assessment of Enrollees’ ongoing care needs.
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Transition of Care Process. Contractor will manage transition of care and continuity of care for new Enrollees and for Enrollees moving from an institutional setting to a community living arrangement. Contractor’s process for facilitating continuity of care will include:
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Related to Transition of Care Process

  • 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.

  • Collection of card When your application is approved by us, we may send you the card, and a renewal or replacement thereof, by ordinary post to the address we have on record for you. In the event you fail to receive the card and unauthorized transactions occur on the card account, you will not be liable for the balances arising therefrom provided you have not acted fraudulently or negligently. We are not liable to you for any loss or damage which you may suffer if you fail to receive the card.

  • Distribution of Written Materials Any written materials distributed by the Trustee to the Beneficiaries pursuant to this Agreement shall be sent by mail (or otherwise communicated in the same manner as Holdings utilizes in communications to holders of Holdings Shares subject to applicable regulatory requirements and provided such manner of communications is reasonably available to the Trustee) to each Beneficiary at its address as shown on the books of the Partnership. The Partnership shall provide or cause to be provided to the Trustee for purposes of communication, on a timely basis and without charge or other expense: (a) a current List; and (b) upon the request of the Trustee, mailing labels to enable the Trustee to carry out its duties under this Agreement.

  • Complaints Process The School shall establish and adhere to a process for resolving public complaints which shall include an opportunity for complainants to be heard. The final administrative appeal shall be heard by the School's Governing Board, except where the complaint pertains to a possible violation of any law or term under this Contract. The complaints process shall be readily accessible from the School’s website, as described in Section 11.4.1.

  • Selection of Carrier The selection of the insurance carrier and policy shall be made by the School District as provided by law.

  • Application Process The employees wishing to enter into a job share arrangement will apply in writing to the Employer and forward a copy to the Union outlining the proposed commencement date of the job share, how the hours and days of work will be shared and how communication and continuity of work will be maintained. The Employer shall communicate a decision on a job share request in writing to the applicants. Applications to Job Sharing shall not be unreasonably denied.

  • Due Process A teacher shall be entitled to Union representation at any conference held during this procedure in which the teacher will be advised of an impending adverse personnel action.

  • Continuity of Care OMPP is committed to providing continuity of care for members as they transition between various IHCP programs and the Contractor’s enrollment. The Contractor shall have mechanisms in place to ensure the continuity of care and coordination of medically necessary health care services for its Hoosier Healthwise members. The State emphasizes several critically important areas where the Contractor shall address continuity of care. Critical continuity of care areas include, but are not limited to:  Transitions for members receiving HIV, Hepatitis C and/or behavioral health services, especially for those members who have received prior authorization from their previous MCE or through fee-for-service;  Transitions for members who are pregnant;  A member’s transition into the Hoosier Healthwise program from traditional fee-for- service or HIP;  A member’s transition between MCEs, particularly during an inpatient stay;  A member’s transition between IHCP programs, Members exiting the Hoosier Healthwise program to receive excluded services;  A member’s exiting the Hoosier Healthwise program to receive excluded services;  A member’s transition to a new PMP;  A member’s transition to private insurance or Marketplace coverage; and  A member’s transition to no coverage. In situations such as a member or PMP disenrollment, the Contractor shall facilitate care coordination with other MCEs or other PMPs. When receiving members from another MCE or fee-for-service, the Contractor shall honor the previous care authorizations for a minimum of thirty (30) calendar days from the member’s date of enrollment with the Contractor. Contractor shall establish policies and procedures for identifying outstanding prior authorization decisions at the time of the member’s enrollment in their plan. For purposes of clarification, the date of member enrollment for purposes of the prior authorization time frames set forth in this section begin on the date the Contractor receives the member’s fully eligible file from the State. Additionally, when a member transitions to another source of coverage, the Contractor shall be responsible for providing the receiving entity with information on any current service authorizations, utilization data and other applicable clinical information such as disease management, case management or care management notes. This process shall be overseen by the Transition Coordination Manager. The Contractor will be responsible for care coordination after the member has disenrolled from the Contractor whenever the member disenrollment occurs during an inpatient stay. In these cases, the Contractor will remain financially responsible for the hospital DRG payment and any outlier payments (without a capitation payment) until the member is discharged from the hospital or the member’s eligibility in Medicaid terminates. The Contractor shall coordinate discharge plans with the member’s new MCE. See Section 3.7.5 for additional requirements regarding continuity of care for behavioral health services. The Hoosier Healthwise MCE Policies and Procedures Manual describes the Contractor’s continuity and coordination of care responsibilities in more detail.

  • Informal Process The Informal Process provides an Employee with the opportunity to resolve his or her concern by using the open door process, with the assistance of a FC member, within 30 calendar days of the date the Employee became aware of the issue. While an Employee may speak with anyone in the open door process regarding a concern or problem, the Employee is encouraged to take this concern up with his immediate supervisor or may request the assistance of the Employee Advocate or a FC member to facilitate resolution of the issue.

  • Process a. The grievance shall be referred to one of the following arbitrators: i. Xxxx Xxxxx ii. Xxxxx Xxxxxx iii. Xxxxx Xxxxxxxx

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