Common use of Clinical Practice Guidelines Clause in Contracts

Clinical Practice Guidelines. The Contractor shall: Adopt, disseminate, and monitor the use of clinical practice guidelines relevant to Enrollees that: Are based on valid and reliable clinical evidence or a consensus of health care professionals or professionals with expertise in the assessment and delivery of long‑term services and supports in the relevant field, community‑based support services or the Contractor’s approved behavioral health performance specifications and Clinical Criteria; Stem from recognized organizations that develop or promulgate evidence‑based clinical practice guidelines, or are developed with involvement of board‑certified providers from appropriate specialties or professionals with expertise in the assessment and delivery of long‑term services and supports; Do not contradict existing Massachusetts‑promulgated guidelines as published by the Department of Public Health, the Department of Mental Health, or other State agencies; Prior to adoption, have been reviewed by the Contractor’s Medical Director, as well as other One Care Plan practitioners and Network Providers, as appropriate; and Are reviewed and updated, as appropriate, or at least every two (2) years. Guidelines shall be reviewed and revised, as appropriate based on changes in national guidelines, or changes in valid and reliable clinical evidence, or consensus of health care and LTSS professionals and providers; For guidelines that have been in effect two years or longer, the Contractor must document that the guidelines were reviewed with appropriate practitioner involvement, and were updated accordingly; Disseminate, in a timely manner, the clinical guidelines to all new Network Providers, to all affected providers, upon adoption and revision, and, upon request, to Enrollees and Eligible Beneficiaries. The Contractor shall make the clinical and practice guidelines available via the Contractor’s Web site. The Contractor shall notify providers of the availability and location of the guidelines, and shall notify providers whenever changes are made; Establish explicit processes for monitoring the consistent application of clinical and practice guidelines across Utilization Management decisions and Enrollee education; and Submit to EOHHS a listing and description of clinical guidelines adopted, endorsed, disseminated, and utilized by the Contractor, upon request.