ADDENDUM TO CARE COORDINATION AGREEMENTCare Coordination Agreement • May 5th, 2020
This Addendum supplements the Care Coordination Agreement executed by [IHS/Tribal Facility] and [non-IHS/Tribal Provider] on [Date], hereinafter referred to as “Initial CCA,” and runs concurrently with the terms of the Initial CCA. The terms of the Initial CCA apply to this Addendum, including, but not limited to, terms governing the Initial CCA’s beginning date and expiration date, as well as applicable methods of amendment, extension, renewal, and termination, unless explicitly contradicted by language in this Addendum, in which case the language of this Addendum controls.
Sample Care Coordination AgreementCare Coordination Agreement • April 3rd, 2014
– Patient/family made aware of and in agreement with reason for referral, type of referral, and selection of subspecialist/specialist
SAMPLE CARE COORDINATION AGREEMENTCare Coordination Agreement • May 13th, 2016
This sample Care Coordination Agreement is between a fictional Certified Community Behavioral Health Clinic (CCBHC), Behavioral Health Clinic, and a fictional hospital, Community Hospital, for the provision of acute care and hospital outpatient services. Note that this sample Care Coordination Agreement is not a template, but is provided as an example. Care Coordination Agreements must be drafted to reflect the unique characteristics of each care coordination relationship.
ContractCare Coordination Agreement • July 6th, 2023
Care Coordination Agreement for Children’s Special Healthcare Services (CSHCS)Care Coordination Agreement • December 3rd, 2012
This agreement is made and entered into this <date> day of <month>, in the year <2012> by and between <MHP Name> (Health Plan) and <LHD Name> (LHD).
Re: RY 2024 Medicare Performance Adjustment Year 5 Attribution and Care Coordination Agreement AttestationCare Coordination Agreement • March 4th, 2022
The Medicare Performance Adjustment (MPA) policy attribution will change from the traditional primary-care based algorithm to a geographic approach for Calendar Year 2022. Since the geographic attribution does not establish any treatment relationships, HSCRC has established an additional approach for data sharing in order to support hospital care redesign efforts.
AGREEMENT BETWEEN THE [NAME OF TRIBAL ENTITY] AND [NAME OF PROVIDER] TO ENTER INTO A CARE COORDINATION ARRANGEMENT AS DESCRIBED IN the CenterCare Coordination Agreement • June 22nd, 2022
Based upon Hospitalist and Community Provider Service Agreement PolicyCare Coordination Agreement • December 11th, 2019
In the interest of improving communication between the Primary Care Physicians of our community and the Hospitalist Inpatient Care Team at Saint Joseph Health System, an agreement between Saint Joseph Health System and it’s contracted hospitalist physician group (hereafter referred to as HCT) and Dr. (hereafter referred to as PCP) do jointly enter into this Care Coordination Agreement with the intention of defining the roles of each party to maximize communication and coordination of Patient Care.
ContractCare Coordination Agreement • May 2nd, 2022
Care Coordination Agreement for Children’s Special Health Care Services (CSHCS)Care Coordination Agreement • January 2nd, 2014
This agreement is made and entered into this day of in the year by and between MICHILD HEALTH PLAN Name (Health Plan) and LHD Name (LHD).
AGREEMENT BETWEEN THE IHS GREAT PLAINS AREA AND [NAME OF PROVIDER] TO ENTER INTO A CARE COORDINATION ARRANGEMENT AS DESCRIBED IN the Center for Medicaid and CHIP Services’ State Health Official Letter 16-002Care Coordination Agreement • May 22nd, 2017
This Agreement is between the [name of PROVIDER](hereinafter PROVIDER) and the IHS Great Plains Area, The IHS Great Plains Area has authority to administer and contract on behalf of the Covered IHS Facilities listed in section II of this Agreement. In entering into this Agreement, the IHS Great Plains Area binds the Covered IHS Facilities to the obligations described in this Agreement.
CARE COORDINATION AGREEMENTCare Coordination Agreement • September 25th, 2018 • Arkansas
CSHCS Alert #1-2014 - CSHCS/MIChild Care Coordination Agreement Thu 1/2/2014 12:22 PMCare Coordination Agreement • January 3rd, 2014
Attached please find the Local Health Department (LHD) and MIChild Health Plan Care Coordination Agreement (CCA) for Children’s Special Health Care Services (CSHCS) template. The purpose of this
AGREEMENTCare Coordination Agreement • November 2nd, 2020
(“Coordinating Agency”) a Not-For-Profit corporation duly organized and existing under the laws of the State of New York, Community Connections of NY, Inc., ("CCNY"), a Not-For-Profit corporation duly organized and existing under the laws of the State of New York and (“Vendor”), a Not-For-Profit corporation.
ContractCare Coordination Agreement • July 22nd, 2019
Mesa County Physicians IPA Care Coordination Agreement Referral FormCare Coordination Agreement • October 24th, 2017
PROVIDER REFERRAL REQUEST FORM REFERRING TO Specialty: Phone: Fax: Date: Practice Name & Address: Please Schedule (select all that apply): Urgent-- Referring physician called Routine Appointment with Specific Physician listed: First Available with any Physician Referring Provider’s Name: Phone: Fax: TYPE OFREFERRAL Medical Consultation with treatment recommendations that primary care physician will continue to follow Procedural Consultation Specialist to Specialist*–Secondary Referral*Send copy of this referral to patient’s Primary Care Physician. Co-management: Assume principal care for this condition Other (designate) Co-management: I prefer to share the care for this condition PATIENTINFORMATION Patient Full Legal Name: DOB If patient is under 18 years old – Parent Contact Name: Preferred Phone: Best time to call: Special Patient Considerations: Patient Insurance Information: Patient’s Primary Care Provider: Phone: Fax: GENERALINFORMATION Reason for Referral (Clin
Model Care Coordination Agreement for Primary Care-Hospital Care TeamCare Coordination Agreement • August 18th, 2017
If admission³ directly initiated by PCP: Discuss case with HCT member on duty in preparation for admission Provide demographics Patient name, DOB, and contact information Contact person if not patient e.g. healthcare proxy or guardian Any special considerations required such as vision/hearing impairment, cognitive deficits, language/cultural preferences PCP designation, referring provider, contact information Provide reason for hospitalization Primary complaint/medical issue/assessment and diagnosis Relevant notes, key physical findings and/or test results as well as summary of recent changes in status Any co-morbid conditions that will need attention during hospitalization Prepare patient/family/caregiver Ensure there is understanding of and agreement with planned hospitalization Ensure safe transfer to the appropriate facility in manner that takes into account patient preferences Provide hospital contact information and expected time frame for hospital length of stay For any hospital
AGREEMENT BETWEEN THE GREAT PLAINS AREA INDIAN HEALTH SERVICE ANDCare Coordination Agreement • October 25th, 2017
AGREEMENT BETWEEN THE NORTH DAKOTA DEPARTMENT OF HUMAN SERVICES (DEPARTMENT) AND [NAME OF TRIBAL GOVERNMENT] TO ENTER INTO A CARE COORDINATION AGREEMENT AS REQUIRED BY NORTH DAKOTA CENTURY CODE (NDCC) SECTION 50-24.1-40.Care Coordination Agreement • June 27th, 2022
This Agreement is between the DEPARTMENT and [name of Tribal Entity]. In entering into this Agreement, the [name of Tribal Entity] is bound to the requirements in NDCC section 50-24.1-40 and this Agreement:
CARE COORDINATION AGREEMENT BETWEEN THE IHS [name of AREA] AREA AND [NAME OF URBAN INDIAN ORGANIZATION (UIO) PROVIDER] AS DESCRIBED IN the Center for Medicaid and CHIP Services’ State Health Official Letter 16-002Care Coordination Agreement • November 26th, 2019
This Agreement is between the [name of URBAN INDIAN ORGANIZATION PROVIDER] (hereinafter PROVIDER) and the IHS [name of AREA] Area. The IHS [name of AREA] Area has authority to enter into this Agreement on behalf of the Covered IHS Facilities listed in section II of this Agreement. In entering into this Agreement, the IHS [name of AREA] Area binds the Covered IHS Facilities to the obligations described in this Agreement.
Certified Community Behavioral Health Clinic CARE COORDINATION AGREEMENTCare Coordination Agreement • June 3rd, 2021
This Care Coordination Agreement (the “Agreement”) serves to confirm the mutual understandings of The Nord Center, which received a Certified Community Behavioral Health Clinic (“CCBHC”) Expansion Grant from the Substance Abuse and Mental Health
Care Coordination Agreement (Transfer and Referral Agreement)Care Coordination Agreement • November 11th, 2022
Please sign and return the attached care coordination agreement (CCA), titled Transfer and Referral Agreement by the tribal health organization, along with your Provider Enrollment Agreement. By signing the CCA, you enable the Department of Health to secure a higher percentage of federal funding for services provided by non-tribal providers to Medicaid recipients who are American Indian/Alaska Native (AI/AN).
ACP HIGH VALUE CARE IMMUNIZATION REFERRAL TOOLKITCare Coordination Agreement • October 20th, 2022
ContractCare Coordination Agreement • October 7th, 2015
PCPOhrouiynmrstoiacfcifyaticnPCeeaSprigseleonOdnagft(fuePicsrletao/(PsDaelebaPaitdresientbP)yrintht)e aboCvaereguCidoeolridniensattoiopnrPCSoAphovgeynirdcsteeiaecacicmlatoynPeoCenSrdartigsrinoneanaOt(ufPfdrilececea/as(rDePealPeftoreairsneot)uPrripnat)tients. This agreement is not legally binding but is a general set of guidelines for provider interaction and patient access. Deviation from these guidelines may be necessary for unique patient care situations. This agreement will be reviewed every two years or more frequently if one party implements a substantial change to their process.
CARE COORDINATION AGREEMENT BETWEENCare Coordination Agreement • January 7th, 2019
This Care Coordination Agreement (the Agreement) serves to confirm the mutual understandings of The HARRIS CENTER for Mental Health and IDD (The HARRIS CENTER), and Michael E. DeBakey VA Medical Center, a referral partner (Partner) for those individuals who receive community-based mental health and/or substance use disorder services from The HARRIS CENTER, in accordance with the terms set forth below. The purpose of this Agreement is to set forth the parties' understanding regarding their collaborative treatment planning and care coordination activities.
IHS CARE COORDINATION AGREEMENTS AND REFFERALSCare Coordination Agreement • October 14th, 2021
Services referred by Great Plains Area IHS facility to a provider that has a fully executed care coordination agreement with Great Plains Area IHS facility are eligible for 100 percent Federal Medical Assistance Percentage (FMAP).
BulletinCare Coordination Agreement • December 30th, 2008
Effective October 1, 2008, the Medical Services Administration (MSA), per policy bulletin MSA 08-42, mandated the enrollment of all newly eligible Medicaid pregnant women into managed care. In addition, MSA 08-42 also carved-out MIHP services from the MHP. The purpose of this policy bulletin is to further define the level of communications between the MIHP and the MHP providers through the initiation of a care coordination agreement. The intent of this care coordination agreement is to define the responsibilities and relationship between the MIHP providers and the MHPs, and to provide guidance delineating the communication expectations between the two agencies.
Care Coordination AgreementCare Coordination Agreement • October 10th, 2018
To outline the expectations for the optimal co-management of outpatients between the Western Colorado Pediatric Associates and the Allergy and Asthma Center of Western Colorado.
CARE COORDINATION AGREEMENT BETWEENCare Coordination Agreement • October 10th, 2024
This Care Coordination Agreement (the Agreement) serves to confirm the mutual understandings of The Harris Center for Mental Health and IDD (The Harris Center) and Michael E. DeBakey VA Medical Center a referral partner for those individuals who receive community-based mental health and/or substance use disorder services from The Harris Center, in accordance with the terms set forth below. The purpose of this Agreement is to set forth the parties' understanding regarding their collaborative treatment planning and care coordination activities.
ContractCare Coordination Agreement • April 4th, 2016
AGREEMENT BETWEEN THE IHS GREAT PLAINS AREA AND [NAME OF PROVIDER] TO ENTER INTO A CARE COORDINATION ARRANGEMENT AS DESCRIBED IN [SHO]
Care Coordination AgreementCare Coordination Agreement • July 16th, 2014
Co-managing Providers – Two or more providers coordinating care on behalf of a shared patient Consultation – assess patient for specific need and transfer back to PCP after one or two visits Co-management - provide long-term care in conjunction with the PCP for a specific illness or episode of care Transfer of care – become primary giver of care due to illness and responsible for all care needs Chronic care management services – delivered to patients with two or more chronic conditions, expected to last at least 12 months, place the patient at significant risk of death or exacerbation/functional decline; comprehensive care plan established and implemented
RE: Care Coordination Agreement with CenClear ServicesCare Coordination Agreement • April 18th, 2019
Attached is a Care Coordination Agreement between State College Area School District and CenClear for a coordination of care activities and collaborative treatment planning. This agreement will remain in place for two-years from the date of respective signatures. I have reviewed the document and I am recommending that the enclosed Care and Coordination Agreement with CenClear Services be approved by the School Board.
AGREEMENT RENEWALCare Coordination Agreement • January 17th, 2023
This Agreement renewal is made to the Care Coordination Agreement with the initial term of October 1, 2022 to August 31, 2021 between Spindletop Center (STCTR) and Hardin County Health Department with a first renewal term of September 1, 2021 through August 31, 2022. This second renewal has an effective date of September 1, 2022 (collectively, the “Agreement”).
Care Coordination Agreement 2Care Coordination Agreement • May 9th, 2024
Care coordination agreement - means an agreement between a health care provider and tribal health care organization which will result in 100% federal funding (FMAP) for eligible medical assistance provided to an American Indian.
IHS CARE COORDINATION AGREEMENTS AND REFFERALSCare Coordination Agreement • August 29th, 2022
Services referred by Great Plains Area IHS facility to a provider that has a fully executed care coordination agreement with Great Plains Area IHS facility are eligible for 100 percent Federal Medical Assistance Percentage (FMAP).
