Care Integration Sample Clauses
Care Integration. The terms and conditions of Section 9, Exhibit B, Part 4 in the Medicaid Contract are incorporated by reference and have the same force and effect as though they are fully set forth herein.
Care Integration a. Contractor shall ensure the provision of the following elements of Care Integration:
Care Integration a. Contractor shall ensureprovide the provision of the following elements of Care Integrationintegrated care as set forth in this Para. a, Sec. 9, Ex. B, Part 4. Accordingly, Contractor must:
(1) Mental Health and Substance Use Disorders Treatment:Integrate Outpatient behavioral healthBehavioral Health treatment shall be integrated intowith a person-centered care delivery system andwhich must be coordinated with physical health care services by Contractor and by Contractor’s transformed health system.;
(2) Oral Health: Contractor shall provideProvide adequate and appropriate access to dental providersProviders for oral healthOral Health services.
(3) Hospital and Specialty Services: Contractor shall provideProvide adequate, timely and appropriate access to specialty and Hospital services. Contractor’s service agreements with specialty and Hospital Providers shallmust: (i) address the coordinating role of patient-centered primary care; shall(ii) specify processes for requesting Hospital admission or specialty services; and shall(iii) establish performance expectations for communication and medical records sharing for specialty treatments, : (x) at the time of Hospital admission or (y) at the time of Hospital discharge, for the purpose of facilitating after-Hospital follow up appointments and care. Contractor shall demonstrate howis responsible for holding Hospitals and specialty service providers areProviders accountable for achieving successful transitions of care. Contractor shall ensure that’s primary care teams transitionare responsible for transitioning Members out of Hospital settings into the most appropriate, independent, and integrated care settings, including Contract # (XXXXXX) CCO 2.0 Contract Template Exhibit B – Statement of Work – Part 4 – Providers and Delivery System Page 92 of 358 home and community-basedCommunity-Based as well as Hospice and other palliative care settings.
(4) Engage in collaborative care coordination for FBDE Members with Contractor’s Affiliated MA or DSN Plans, or both as applicable.
b. Contractor shall ensureis responsible for documenting, and maintaining such documentation, that Members have been provided with all of the following features of the delivery system:
(1) Each as set forth below. Accordingly, Contractor must have documentation demonstrating that, as applicable, each Member has:
(1) Had access to a consistent and stable relationship with a primary care team that is responsible for comprehensive care managem...