Common use of Care Coordination for Special and High Needs Populations Clause in Contracts

Care Coordination for Special and High Needs Populations. The CONTRACTOR’s Care Coordination program description shall reflect Care Coordination requirements specific to special and high needs populations described in this Section 4.4.9. For JUST Health TOC Members, the CONTRACTOR shall complete the Justice Involved TOC Assessment/Plan/HRA template that is in Section 5.12 of the Managed Care Policy Manual. For Members receiving services from CSAs, CCBHCs, CYFD, ECECD, DOH, Corrections, School Systems, FQHCs, Housing Entities, BHSD, and/or other Member-serving entities, the CONTRACTOR shall ensure that the Member-serving agency or entity is included in Care Coordination processes described in Section 4.4 of this Agreement. For Members receiving HCBS in a provider owned or controlled setting, the care coordinator shall assess Member experience and provider compliance with federal home- and community-based (HCB) settings requirements during face-to-face visits with Members, using the process and tools approved by HCA. The care coordinator’s assessment is intended to determine ongoing provider compliance with federal HCB settings requirements. The CONTRACTOR shall employ or contract with dedicated care coordinators and supervisors with relevant expertise to meet the needs for each population listed below. The dedicated number of care coordinators for each population must be commensurate with the proportion of the CONTRACTOR’s enrollment size for each of these populations. Justice-Involved Individuals; Traumatic Brain Injury Members; Medically Fragile Members; Individuals with Intellectual Disabilities; Children and Adults with Special Health Care Needs; Members with Housing Insecurity needs; Members with complex Behavioral Health needs, including SUD; CISC; and CARA Members. Comprehensive Addiction Recovery Act (CARA) program The Comprehensive Addiction Recovery Act (CARA) is a 2016 federal law-that amended the Child Abuse and Treatment Act (CAPTA), was adopted in New Mexico in 2019 under legislation (HB230), and is administered by CYFD, HCA, and ECECD. CARA is a program that offers supports and services to the families of babies who are born with exposure to substances that can affect their health and development. These substances include, but are not limited to alcohol, nicotine, marijuana, and drugs or medications, including controlled or prescribed substances such as opioids. XXXX requires that all infants born exposed to substances have a comprehensive plan of care created by the hospital discharge team and that utilization of supportive services by the mothers and infant are tracked by the CONTRACTOR. The success of the CARA program relies heavily on intensive care coordination. CARA Members are part of the maternal and child health targeted population, and as such, the CONTRACTOR shall ensure that all care coordination activities for CARA Members are provided through its Full Delegation Model. However, the CONTRACTOR shall provide additional monitoring and oversight of the delegated care coordination and the services provided to CARA Members. The CONTRACTOR shall develop a written plan for monitoring and overseeing delegated care coordination and the services provided to CARA Members subject to HCA approval to ensure compliance with the following program requirements: Use of the “treat first” model of care. The CONTRACTOR shall ensure that no medically necessary services are withheld or delayed awaiting completion of the CNA. Contact is made with the CARA mother and the guardian of the infant (if they are different people) and the HRA is completed within twenty-four (24) hours of discharge from the hospital. The CONTRACTOR shall ensure that, whenever possible, completion of the HRA and the first contact with the family shall be made in the hospital. CNAs are performed in person and completed within seven days of first contact. Three attempts to contact mother are made within the first 48 hours of discharge. The CONTRACTOR shall ensure that if the care coordinator is unable to reach the mother and the baby is in the mother’s custody, the care coordinator contacts the CARA navigation team to relay contact limitations and seek other options for member contact. Care coordinators serving CARA Members regularly meet with XXXX Member-assigned pediatricians, hospitals, and home visiting agencies in their community to discuss communication challenges and processes. Care coordinators serving CARA Members complete a transition plan to the CARA navigation team within 60 days prior to the Member’s graduation from the CARA program (at the one year mark) to ensure continuity of care for the Member. The CARA Member and mother shall be assigned the same care coordinator. The CONTRACTOR shall submit the plan of care created by the hospital, the HRA, and the CNA to the infant’s PCP (pediatrician, midwife, family medicine MD, etc.) within 14 days of discharge from the hospital. At a minimum the CONTRACTOR shall report the following to HCA: The CONTRACTOR’s Member count of CARA Members. The number of plans of care sent by the CONTRACTOR to infant’s PCPs relative to total count of CARA Members. The number of mothers of CARA Members who have utilized behavioral health and substance use treatment services. The number of other Community Based Organization (CBO) services accessed by the mother or guardian of the infant. The number of women who have maintained custody of their CARA Member children for the duration of the first year. The CONTRACTOR shall comply with HCA changes to CARA reporting requirements. Coordination and Collaboration with CYFD The CONTRACTOR shall work with CYFD and other State agencies to promote the early identification of children and transition-age youth (ages sixteen [16] to twenty-one [21]) who are engaged in unlawful behaviors, are high-risk, have experienced traumatic events, and/or may be exhibiting signs of SED or SMI. The CONTRACTOR shall coordinate services and supports that reflect the least restrictive level of care with the CYFD PS, Behavioral Health Services (BHS), and Juvenile Justice Services (JJS) divisions, including discharge planning. Upon request, the CONTRACTOR shall provide and/or participate in trainings regarding service availability to Contract Providers, family members, Kinship Supports, and youth, including but not limited to: Medicaid and Non-Medicaid services and supports available, as appropriate, such as Substance Use Programs, HFW, Youth Support Services, Infant Mental Health Child-Parent Psychotherapy, and Prevention Services targeted to parents and children involved with CYFD; The referral process; and Eligibility criteria to promote coordination and access to services. Training and information shall incorporate and be reflective of a Trauma-informed, youth- and family-driven, and culturally and linguistically responsive approach to care. The CONTRACTOR shall ensure the Member’s care coordinator is actively involved with the CYFD PPW for PS involved children and youth, juvenile probation officer or juvenile facility staff for JJS involved youth, and BHS community behavioral health clinician for CYFD involved children/youth, provided that CYFD informs the CONTRACTOR of the assigned CYFD lead worker. The CONTRACTOR shall ensure that children in the custody or supervision of CYFD receive a Behavioral Health screening within forty-eight (48) hours of a referral to a Behavioral Health Contract Provider and receive a Behavioral Health assessment, access to Medically Necessary Covered Services, and Care Coordination as appropriate. The CONTRACTOR shall participate in all PS, BHS, and JJS clinical staffing reviews related to the CYFD care planning process. Upon request, the CONTRACTOR shall participate in the PS Family Centered Meetings, JJS Multi-Disciplinary Team meetings, and/ or Behavioral Health team meetings, which shall include family members or Kinship Supports, as appropriate. For Members receiving services through Comprehensive Community Support Services (CCSS) and HFW service models, the CONTRACTOR shall ensure the participation of the Member’s MCO care coordinator and include other stakeholders in the development of the service plan as described in NMAC. The CONTRACTOR shall engage in the BHSD-facilitated billing and credentialing meetings and find ways to reduce or remove provider administrative barriers for accessing Behavioral Health services and implementing HFW. The CONTRACTOR shall collaborate with CYFD for CYFD involved children and youth experiencing a transition. Transitions include: Moving from a higher level of care to a lower level of care; Moving from a residential placement or institutional facility (including psychiatric hospitals) to a community placement; Moving from an out-of-state placement to an in-state placement; Being released from incarceration or detention facilities; Entering or returning home from a xxxxxx care placement; and Turning twenty-one (21) years of age. The CONTACTOR shall ensure an appropriate level of Care Coordination to meet the needs and ensure that the child or youth is placed in the least restrictive placement.

Care Coordination for Special and High Needs Populations. The CONTRACTOR’s Care Coordination program description shall reflect Care Coordination requirements specific to special and high needs populations described in this Section 4.4.9. For JUST Health TOC Members, the CONTRACTOR shall complete the Justice Involved TOC Assessment/Plan/HRA template that is in Section 5.12 of the Managed Care Policy Manual. For Members receiving services from CSAs, CCBHCs, CYFD, ECECD, DOH, Corrections, School Systems, FQHCs, Housing Entities, BHSD, and/or other Member-serving entitiesa CSA or a CCBHC as described in Section 4.8.12 of this Agreement, the CONTRACTOR shall ensure that the Member-serving agency CSA or entity CCBHC is included in Care Coordination processes described in Section 4.4 of this Agreement. For Members receiving HCBS in a provider owned or controlled setting, the care coordinator shall assess Member experience and provider compliance with federal home- and community-based (HCB) settings requirements during face-to-face visits with Members, using the process and tools approved by HCAHSD. The care coordinator’s assessment is intended to determine ongoing provider compliance with federal HCB settings requirements. The CONTRACTOR shall employ or contract with dedicated care coordinators and supervisors with relevant expertise to meet the needs for each population listed below. The dedicated number of care coordinators for each population must be commensurate with the proportion of the CONTRACTOR’s enrollment size for each of these populations. Justice-Involved Individualsinvolved Members; Traumatic Brain Injury Members; Medically Fragile MembersMembers receiving case management services through UNM; Individuals with Intellectual Disabilities; Children and Adults with Special Health Care Needs; Members with Housing Insecurity needs; , Members with complex Behavioral Health needs, including SUD; CISC; and CARA Members. Comprehensive Addiction Recovery Act (CARA) program The Comprehensive Addiction Recovery Act (CARA) is a 2016 federal law-that amended the Child Abuse and Treatment Act (CAPTA), was adopted in New Mexico in 2019 under legislation (HB230), and is administered by CYFD, HCA, and ECECD. CARA is a program that offers supports and services to the families of babies who are born with exposure to substances that can affect their health and development. These substances include, but are not limited to alcohol, nicotine, marijuana, and drugs or medications, including controlled or prescribed substances such as opioids. XXXX requires that all infants born exposed to substances have a comprehensive plan of care created by the hospital discharge team and that utilization of supportive services by the mothers and infant are tracked by the CONTRACTOR. The success of the CARA program relies heavily on intensive care coordination. CARA Members are part of the maternal and child health targeted population, and as such, the CONTRACTOR shall ensure that all care coordination activities for CARA Members are provided through its Full Delegation Model. However, the CONTRACTOR shall provide additional monitoring and oversight of the delegated care coordination and the services provided to CARA Members. The CONTRACTOR shall develop a written plan for monitoring and overseeing delegated care coordination and the services provided to CARA Members subject to HCA approval to ensure compliance with the following program requirements: Use of the “treat first” model of care. The CONTRACTOR shall ensure that no medically necessary services are withheld or delayed awaiting completion of the CNA. Contact is made with the CARA mother and the guardian of the infant (if they are different people) and the HRA is completed within twenty-four (24) hours of discharge from the hospital. The CONTRACTOR shall ensure that, whenever possible, completion of the HRA and the first contact with the family shall be made in the hospital. CNAs are performed in person and completed within seven days of first contact. Three attempts to contact mother are made within the first 48 hours of discharge. The CONTRACTOR shall ensure that if the care coordinator is unable to reach the mother and the baby is in the mother’s custody, the care coordinator contacts the CARA navigation team to relay contact limitations and seek other options for member contact. Care coordinators serving CARA Members regularly meet with XXXX Member-assigned pediatricians, hospitals, and home visiting agencies in their community to discuss communication challenges and processes. Care coordinators serving CARA Members complete a transition plan to the CARA navigation team within 60 days prior to the Member’s graduation from the CARA program (at the one year mark) to ensure continuity of care for the Member. The CARA Member and mother shall be assigned the same care coordinator. The CONTRACTOR shall submit the plan of care created by the hospital, the HRA, and the CNA to the infant’s PCP (pediatrician, midwife, family medicine MD, etc.) within 14 days of discharge from the hospital. At a minimum the CONTRACTOR shall report the following to HCA: The CONTRACTOR’s Member count of CARA Members. The number of plans of care sent by the CONTRACTOR to infant’s PCPs relative to total count of CARA Members. The number of mothers of CARA Members who have utilized behavioral health and substance use treatment services. The number of other Community Based Organization (CBO) services accessed by the mother or guardian of the infant. The number of women who have maintained custody of their CARA Member children for the duration of the first year. The CONTRACTOR shall comply with HCA changes to CARA reporting requirements. Coordination and Collaboration with CYFD The CONTRACTOR shall work with CYFD and other State agencies to promote the early identification of children and transition-age youth (ages sixteen [16] to twenty-one [21]) who are engaged in unlawful behaviors, are high-risk, have experienced traumatic events, and/or may be exhibiting signs of SED or SMI. The CONTRACTOR shall coordinate services and supports that reflect the least restrictive level of care with the CYFD PS, Behavioral Health Services (BHS), and Juvenile Justice Services (JJS) divisions, including discharge planning. Upon request, the CONTRACTOR shall provide and/or participate in trainings regarding service availability to Contract Providers, family members, Kinship Supports, and youth, including but not limited to: Medicaid and Non-Medicaid services and supports available, as appropriate, such as Substance Use Programs, HFW, Youth Support Services, Infant Mental Health Child-Parent Psychotherapy, and Prevention Services targeted to parents and children involved with CYFD; The referral process; and Eligibility criteria to promote coordination and access to services. Training and information shall incorporate and be reflective of a Trauma-informed, youth- and family-driven, and culturally and linguistically responsive approach to care. The CONTRACTOR shall ensure the Member’s care coordinator is actively involved with the CYFD PPW for PS involved children and youth, juvenile probation officer or juvenile facility staff for JJS involved youth, and BHS community behavioral health clinician for CYFD involved children/youth, provided that CYFD informs the CONTRACTOR of the assigned CYFD lead worker. The CONTRACTOR shall ensure that children in the custody or supervision of CYFD receive a Behavioral Health screening within forty-eight (48) hours of a referral to a Behavioral Health Contract Provider and receive a Behavioral Health assessment, access to Medically Necessary Covered Services, and Care Coordination as appropriate. The CONTRACTOR shall participate in all PS, BHS, and JJS clinical staffing reviews related to the CYFD care planning process. Upon request, the CONTRACTOR shall participate in the PS Family Centered Meetings, JJS Multi-Disciplinary Team meetings, and/ or Behavioral Health team meetings, which shall include family members or Kinship Supports, as appropriate. For Members receiving services through Comprehensive Community Support Services (CCSS) and HFW service models, the CONTRACTOR shall ensure the participation of the Member’s MCO care coordinator and include other stakeholders in the development of the service plan as described in NMAC. The CONTRACTOR shall engage in the BHSD-facilitated billing and credentialing meetings and find ways to reduce or remove provider administrative barriers for accessing Behavioral Health services and implementing HFW. The CONTRACTOR shall collaborate with CYFD for CYFD involved children and youth experiencing a transition. Transitions include: Moving from a higher level of care to a lower level of care; Moving from a residential placement or institutional facility (including psychiatric hospitals) to a community placement; Moving from an out-of-state placement to an in-state placement; Being released from incarceration or detention facilities; Entering or returning home from a xxxxxx care placement; and Turning twenty-one (21) years of age. The CONTACTOR shall ensure an appropriate level of Care Coordination to meet the needs and ensure that the child or youth is placed in the least restrictive placement.