Common use of Discharge Planning Clause in Contracts

Discharge Planning. If further care at home or in another facility is appropriate following discharge from the Hospital, Blue Shield will work with the Member, the attending Physician and the Hospital discharge planners to determine the most appropriate and cost effective way to provide this care. Case Management The Benefits Management Program may also include case management, which is a service that provides the assistance of a health care professional to help the Member access necessary services and to make the most efficient use of plan Benefits. The Member’s case manager may also arrange for alternative care benefits to avoid prolonged or repeated hospitalizations, when medically appropriate. Alternative care benefits are only utilized by mutual consent of the Member, the provider, and Blue Shield, and will not exceed the standard Benefits available under this plan. The approval of alternative case benefits is specific to each Member for a specified period of time. Such approval should not be construed as a waiver of Blue Shield’s right to thereafter administer this health plan in strict accordance with its express terms. Blue Shield is not obligated to provide the same or similar alternative care benefits to any other person in any other instance. Palliative Care Services In conjunction with Covered Services, Blue Shield provides palliative care services for Members with serious illnesses. Palliative care services include access to physicians and nurse case managers who are trained to assist Members managing symptoms, maximizing comfort, safety, autonomy and well-being, and navigating a course of care. Members can obtain assistance in making informed decisions about therapy, as well as documenting their quality of life choices. Members may call the Customer Service Department at the number provided on the back page of this Agreement to request more information about these services. Principal Benefits and Coverages (Covered Services) Blue Shield provides the following Medically Necessary Benefits, subject to applicable Deductibles, Copayments, Coinsurance, and charges in excess of Benefit maximums, Participating Provider provisions and Benefits Management Program provisions. Coverage for these services is subject to all terms, conditions, limitations and exclusions of the Evidence of Coverage and Health Agreement, including but not limited to, any conditions or limitations set forth in the Benefit descriptions below, and to the Principal Limitations, Exceptions, Exclusions and Reductions listed in this Evidence of Coverage. All Benefits must be Medically Necessary to be covered. If there are two or more Medically Necessary services that may be provided for the illness, injury or medical condition, Blue Shield will provide Benefits based on the most cost- effective service. The Copayment and Coinsurance amounts for Covered Services, if applicable, are shown on the Summary of Benefits. The Summary of Benefits is provided with, and is incorporated as part of, this Evidence of Coverage and Health Service Agreement. Except as may be specifically indicated, for services received from Non-Participating Providers, subscribers will be responsible for all charges above the Allowable Amount in addition to the indicated Copayment or Coinsurance amount. Except as specifically provided herein, services are covered only when rendered by an individual or entity that is licensed or certified by the state to provide health care services and is operating within the scope of that license or certification.

Discharge Planning. If further care at home or in another facility is appropriate following discharge from the Hospital, Blue Shield or Blue Shield’s MHSA will work with the Member, the attending Physician and the Hospital discharge planners to determine the most appropriate and cost effective way to provide this care. Case Management The Benefits Management Program may also include case management, which is a service that provides the assistance of a health care professional to help the Member access necessary services and to make the most efficient use of plan Benefits. The Member’s nurse case manager may also arrange for alternative care benefits to avoid prolonged or repeated hospitalizations, when medically appropriate. Alternative care benefits are only utilized by mutual consent of the Member, the provider, and Blue Shield or Blue Shield’s MHSA, and will not exceed the standard Benefits available under this plan. The approval of alternative case benefits is specific to each Member for a specified period of time. Such approval should not be construed as a waiver of Blue Shield’s right to thereafter administer this health plan in strict accordance with its express terms. Blue Shield is not obligated to provide the same or similar alternative care benefits to any other person in any other instance. Palliative Care Services In conjunction with Covered Services, Blue Shield provides palliative care services for Members with serious illnesses. Palliative care services include access to physicians and nurse case managers who are trained to assist Members in managing symptoms, in maximizing comfort, safety, autonomy and well-being, and in navigating a course of care. Members can obtain assistance in making informed decisions about therapy, as well as documenting their quality of life choices. Members may call the Customer Service Department at the number provided on the back page of this Agreement to request more information about these services. Principal Benefits and Coverages (Covered Services) Blue Shield provides the following Medically Necessary Benefits, subject to applicable Deductibles, Copayments, Coinsurance, and charges in excess of Benefit maximums, Participating Provider provisions and Benefits Management Program provisions. Coverage for these services is subject to all terms, conditions, limitations and exclusions of the Evidence of Coverage and Health Agreement, including but not limited to, any conditions or limitations set forth in the Benefit descriptions below, and to the Principal Limitations, Exceptions, Exclusions and Reductions listed in this Evidence of Coverage. All Benefits must be Medically Necessary to be covered. If there are two or more Medically Necessary services that may be provided for the illness, injury or medical condition, Blue Shield will provide Benefits based on the most cost- effective service. The Copayment and Coinsurance amounts for Covered Services, if applicable, are shown on the Summary of Benefits. The Summary of Benefits is provided with, and is incorporated as part of, this Evidence of Coverage and Health Service Agreement. Except as may be specifically indicated, for services received from Non-Participating Providers, subscribers will be responsible for all charges above the Allowable Amount in addition to the indicated Copayment or Coinsurance amount. Except as specifically provided herein, services are covered only when rendered by an individual or entity that is licensed or certified by the state to provide health care services and is operating within the scope of that license or certification.

Discharge Planning. If further care at home or in another facility is appropriate following discharge from the Hospital, Blue Shield or Blue Shield’s MHSA will work with the Member, the attending Physician and the Hospital discharge planners to determine the most appropriate and cost effective way to provide this care. Case Management The Benefits Management Program may also include case management, which is a service that provides the assistance of a health care professional to help the Member access necessary services and to make the most efficient use of plan Benefits. The Member’s nurse case manager may also arrange for alternative care benefits to avoid prolonged or repeated hospitalizations, when medically appropriate. Alternative care benefits are only utilized by mutual consent of the Member, the provider, and Blue Shield or Blue Shield’s MHSA, and will not exceed the standard Benefits available under this plan. The approval of alternative case benefits is specific to each Member for a specified period of time. Such approval should not be construed as a waiver of Blue Shield’s right to thereafter administer this health plan in strict accordance with its express terms. Blue Shield is not obligated to provide the same or similar alternative care benefits to any other person in any other instance. Palliative Care Services In conjunction with Covered Services, Blue Shield provides palliative care services for Members with serious illnesses. Palliative care services include access to physicians and nurse case managers who are trained to assist Members in managing symptoms, in maximizing comfort, safety, autonomy and well-being, and in navigating a course of care. Members can obtain assistance in making informed decisions about therapy, as well as documenting their quality of life choices. Members may call the Customer Service Department at the number provided on the back page of this Agreement to request more information about these services. Principal Benefits and Coverages (Covered Services) Blue Shield provides the following Medically Necessary Benefits, subject to applicable Deductibles, Copayments, Coinsurance, and charges in excess of Benefit maximums, Participating Provider provisions and Benefits Management Program provisions. Coverage for these services is subject to all terms, conditions, limitations and exclusions of the Evidence of Coverage and Health Agreement, including but not limited to, any conditions or limitations set forth in the Benefit descriptions below, and to the Principal Limitations, Exceptions, Exclusions and Reductions listed in this Evidence of Coverage. Unless otherwise authorized by Blue Shield or the MHSA, all Benefits must be provided by Participating Providers or MHSA Participating Providers. All Benefits must be Medically Necessary to be covered. If there are two or more Medically Necessary services that may be provided for the illness, injury or medical condition, Blue Shield will provide Benefits based on the most cost- cost-effective service. The Copayment and Coinsurance amounts for Covered Services, if applicable, are shown on the Summary of Benefits. The Summary of Benefits is provided with, and is incorporated as part of, this Evidence of Coverage and Health Service Agreement. Except as may be specifically indicated, for services received from Non-Participating Providers, subscribers will be responsible for all charges above the Allowable Amount in addition to the indicated Copayment or Coinsurance amount. Except as specifically provided herein, services are covered only when rendered by an individual or entity that is licensed or certified by the state to provide health care services and is operating within the scope of that license or certification.

Discharge Planning. If further care at home or in another facility is appropriate following discharge from the Hospital, Blue Shield will work with the Member, the attending Physician and the Hospital discharge planners to determine the most appropriate and cost effective way to provide this care. Case Management The Benefits Management Program may also include case management, which is a service that provides the assistance of a health care professional to help the Member access necessary services and to make the most efficient use of plan Benefits. The Member’s case manager may also arrange for alternative care benefits to avoid prolonged or repeated hospitalizations, when medically appropriate. Alternative care benefits are only utilized by mutual consent of the Member, the provider, and Blue Shield, and will not exceed the standard Benefits available under this plan. The approval of alternative case benefits is specific to each Member for a specified period of time. Such approval should not be construed as a waiver of Blue Shield’s right to thereafter administer this health plan in strict accordance with its express terms. Blue Shield is not obligated to provide the same or similar alternative care benefits to any other person in any other instance. Palliative Care Services In conjunction with Covered Services, Blue Shield provides palliative care services for Members with serious illnesses. Palliative care services include access to physicians and nurse case managers who are trained to assist Members managing symptoms, maximizing comfort, safety, autonomy and well-being, and navigating a course of care. Members can obtain assistance in making informed decisions about therapy, as well as documenting their quality of life choices. Members may call the Customer Service Department at the number provided on the back page of this Agreement to request more information about these services. Principal Benefits and Coverages (Covered Services) Blue Shield provides the following Medically Necessary Benefits, subject to applicable Acupuncture Benefits Benefits are provided for acupuncture evaluation and treatment by a Doctor of Medicine or licensed acupuncturist. Deductibles, Copayments, Coinsurance, and charges in excess of Benefit maximums, Participating Provider provisions and Benefits Management Program provisions. Coverage for these services is subject to all terms, conditions, limitations and exclusions of the Evidence of Coverage and Health Agreement, including but not limited to, any conditions or limitations set forth in the Benefit descriptions below, and to the Principal Limitations, Exceptions, Exclusions and Reductions listed in this Evidence of Coverage. All Benefits must be Medically Necessary to be covered. If there are two or more Medically Necessary services that may be provided for the illness, injury or medical condition, Blue Shield will provide Benefits based on the most cost- effective service. The Copayment and Coinsurance amounts for Covered Services, if applicable, are shown on the Summary of Benefits. The Summary of Benefits is provided with, and is incorporated as part of, this Evidence of Coverage and Health Service Agreement. Except as may be specifically indicated, for services received from Non-Participating Providers, subscribers will be responsible for all charges above the Allowable Amount in addition to the indicated Copayment or Coinsurance amount. Except as specifically provided herein, services are covered only when rendered by an individual or entity that is licensed or certified by the state to provide health care services and is operating within the scope of that license or certification. Allergy Testing and Treatment Benefits Benefits are provided for allergy testing and treatment, including allergy serum. Ambulance Benefits Benefits are provided for (1) ambulance services (ground and air) when used to transport a Member from place of illness or injury to the closest medical facility where appropriate treatment can be received; or (2) authorized ambulance transportation to or from Covered Services.

Discharge Planning. If further care at home or in another facility is appropriate following Upon discharge from the Hospital, Blue Shield will work with the Memberrehabilitation provider, the attending Physician applicant/client will be discharged to an appropriate provider should continued services be necessary and if funding is available or to the Hospital discharge planners care or supervision of their family when funding is not available, or a suitable provider cannot be located. I agree to the above terms and to participate in the Rehabilitation Service Plan as outlined above. Applicant/Client’s Printed Name Date Authorized Representative’s Printed Name Date Applicant/Client’s Signature or Authorized Representative’s Signature HIP Service Provider Terms and Conditions for HIP Service Delivery: The rehabilitation service provider agrees to comply with all terms and conditions specified in their Participating Provider Agreement related to the delivery of services in this rehabilitation service plan. Specific Responsibilities of the Rehabilitation Service Provider Relative to Implementation of Each HIP Service: The rehabilitation service provider agrees to provide the services identified above in the Rehabilitation Service Plan to the applicant/client as proposed. The rehabilitation service provider will perform, at a minimum, quarterly progress reviews to determine the most appropriate client’s progress in meeting the goals and cost effective way to provide this care. Case Management The Benefits Management Program may also include case management, which is a objectives identified in the rehabilitation service that provides the assistance of a health care professional to help the Member access necessary services and to make the most efficient use of plan Benefits. The Member’s case manager may also arrange for alternative care benefits to avoid prolonged or repeated hospitalizations, when medically appropriate. Alternative care benefits are only utilized by mutual consent of the Member, the provider, and Blue Shield, and will not exceed the standard Benefits available under this plan. The approval results of alternative case benefits the progress reviews will be conveyed to the client and his or her authorized representative. Financial Responsibility of the Applicant, HIP and any Third Party: The Provider shall not bill enrolled patients, in part or in full, for any services listed on the Fee Schedule except where the Provider is specific so instructed, in writing, by the Department. Invoices submitted to each Member the Department for enrolled patients who are expected to share in the cost of services will be rejected by the Department, in whole or in part, and the provider will be instructed, in writing, by the Department to bill the patient in whole or in part. The Head Injury Program will reimburse the rehabilitation service provider, according to the approved fee schedule in the Participating Provider Agreement, after the provider bills the client when instructed by the Head Injury Program, the client’s third-party insurance and all other state programs. The Head Injury Program is a specified period payer of timelast resort according to the Participating Provider Agreement. Such approval should not be construed as a waiver of Blue Shield’s right I agree to thereafter administer this health plan in strict accordance with its express the above terms. Blue Shield is not obligated , to provide services as described above, to conduct progress reviews and to promote the same applicant/client’s achievement of his or similar alternative care benefits her rehabilitation goals. Printed Name, Program Director, Rehabilitation Provider Signature, Program Director, Rehabilitation Provider Date This form is to any other person be maintained in any other instancethe client’s file and available for inspection upon the Department’s request. Palliative Care Services In conjunction with Covered Services, Blue Shield provides palliative care HD002394 rev. 9/22 Appendix B DEPARTMENT OF HEALTH PAYMENT PROVISIONS The Department agrees to pay the Contractor for services for Members with serious illnesses. Palliative care services include access rendered pursuant to physicians and nurse case managers who are trained to assist Members managing symptoms, maximizing comfort, safety, autonomy and well-being, and navigating a course of care. Members can obtain assistance in making informed decisions about therapy, as well as documenting their quality of life choices. Members may call the Customer Service Department at the number provided on the back page of this Agreement to request more information about these services. Principal Benefits and Coverages (Covered Services) Blue Shield provides the following Medically Necessary Benefits, subject to applicable Deductibles, Copayments, Coinsurance, and charges in excess of Benefit maximums, Participating Provider provisions and Benefits Management Program provisions. Coverage for these services is subject to all terms, conditions, limitations and exclusions of the Evidence of Coverage and Health Agreement, including but not limited to, any conditions or limitations set forth in the Benefit descriptions below, and to the Principal Limitations, Exceptions, Exclusions and Reductions listed in this Evidence of Coverage. All Benefits must be Medically Necessary to be covered. If there are two or more Medically Necessary services that may be provided for the illness, injury or medical condition, Blue Shield will provide Benefits based on the most cost- effective service. The Copayment and Coinsurance amounts for Covered Services, if applicable, are shown on the Summary of Benefits. The Summary of Benefits is provided with, and is incorporated as part of, this Evidence of Coverage and Health Service Agreement. Except as may be specifically indicated, for services received from Non-Participating Providers, subscribers will be responsible for all charges above the Allowable Amount in addition to the indicated Copayment or Coinsurance amount. Except as specifically provided herein, services are covered only when rendered by an individual or entity that is licensed or certified by the state to provide health care services and is operating within the scope of that license or certification.follows:

Discharge Planning. If further care at home or in another facility is appropriate following discharge from the Hospital, Blue Shield will work with the Member, the attending Physician and the Hospital discharge planners to determine the most appropriate and cost effective way to provide this care. Case Management The Benefits Management Program may also include case management, which is a service that provides the assistance of a health care professional to help the Member access necessary services and to make the most efficient use of plan Benefits. The Member’s case manager may also arrange for alternative care benefits to avoid prolonged or repeated hospitalizations, when medically appropriate. Alternative care benefits are only utilized by mutual consent of the Member, the provider, and Blue Shield, and will not exceed the standard Benefits available under this plan. The approval of alternative case benefits is specific to each Member for a specified period of time. Such approval should not be construed as a waiver of Blue Shield’s right to thereafter administer this health plan in strict accordance with its express terms. Blue Shield is not obligated to provide the same or similar alternative care benefits to any other person in any other instance. Palliative Care Services In conjunction with Covered Services, Blue Shield provides palliative care services for Members with serious illnesses. Palliative care services include access to physicians and nurse case managers who are trained to assist Members managing symptoms, maximizing comfort, safety, autonomy and well-being, and navigating a course of care. Members can obtain assistance in making informed decisions about therapy, as well as documenting their quality of life choices. Members may call the Customer Service Department at the number provided on the back page of this Agreement to request more information about these services. Principal Benefits and Coverages (Covered Services) Blue Shield provides the following Medically Necessary Benefits, subject to applicable Deductibles, Copayments, Coinsurance, and charges in excess of Benefit maximums, Participating Provider provisions and Benefits Management Program provisions. Coverage for these services is subject to all terms, conditions, limitations and exclusions of the Evidence of Coverage and Health Agreement, including but not limited to, any conditions or limitations set forth in the Benefit descriptions below, and to the Principal Limitations, Exceptions, Exclusions and Reductions listed in this Evidence of Coverage. All Benefits must be Medically Necessary to be covered. If there are two or more Medically Necessary services that may be provided for the treatment can be received; or (2) authorized ambulance transportation to or from Covered Services. Ambulatory Surgery Center Benefits Benefits are provided for surgery performed in an Ambulatory Surgery Center. illness, injury or medical condition, Blue Shield will provide Benefits based on the most cost- effective service. The Copayment and Coinsurance amounts for Covered Services, if applicable, are shown on the Summary of Benefits. The Summary of Benefits is provided with, and is incorporated as part of, this Evidence of Coverage and Health Service Agreement. Except as may be specifically indicated, for services received from Non-Participating Providers, subscribers will be responsible for all charges above the Allowable Amount in addition to the indicated Copayment or Coinsurance amount. Except as specifically provided herein, services are covered only when rendered by an individual or entity that is licensed or certified by the state to provide health care services and is operating within the scope of that license or certification.

Discharge Planning. If further care at home or in another facility is appropriate following discharge from the Hospital, Blue Shield will work with the Member, the attending Physician and the Hospital discharge planners to determine the most appropriate and cost effective way to provide this care. Case Management The Benefits Management Program may also include case management, which is a service that provides the assistance of a health care professional to help the Member access necessary services and to make the most efficient use of plan Benefits. The Member’s case manager may also arrange for alternative care benefits to avoid prolonged or repeated hospitalizations, when medically appropriate. Alternative care benefits are only utilized by mutual consent of the Member, the provider, and Blue Shield, and will not exceed the standard Benefits available under this plan. The approval of alternative case benefits is specific to each Member for a specified period of time. Such approval should not be construed as a waiver of Blue Shield’s right to thereafter administer this health plan in strict accordance with its express terms. Blue Shield is not obligated to provide the same or similar alternative care benefits to any other person in any other instance. Palliative Care Services In conjunction with Covered Services, Blue Shield provides palliative care services for Members with serious illnesses. Palliative care services include access to physicians and nurse case managers who are trained to assist Members managing symptoms, maximizing comfort, safety, autonomy and well-being, and navigating a course of care. Members can obtain assistance in making informed decisions about therapy, as well as documenting their quality of life choices. Members may call the Customer Service Department at the number provided on the back page of this Agreement to request more information about these services. Principal Benefits and Coverages (Covered Services) Blue Shield provides the following Medically Necessary Benefits, subject to applicable Acupuncture Benefits Benefits are provided for acupuncture evaluation and treatment by a Doctor of Medicine or licensed acupuncturist. Deductibles, Copayments, Coinsurance, and charges in excess of Benefit maximums, Participating Provider provisions and Benefits Management Program provisions. Coverage for these services is subject to all terms, conditions, limitations and exclusions of the Evidence of Coverage and Health Agreement, including but not limited to, any conditions or limitations set forth in the Benefit descriptions below, and to the Principal Limitations, Exceptions, Exclusions and Reductions listed in this Evidence of Coverage. All Benefits must be Medically Necessary to be covered. If there are two or more Medically Necessary services that may be provided for the illness, injury or medical condition, Blue Shield will provide Benefits based on the most cost- effective service. The Copayment and Coinsurance amounts for Covered Services, if applicable, are shown on the Summary of Benefits. The Summary of Benefits is provided with, and is incorporated as part of, this Evidence of Coverage and Health Service Agreement. Except as may be specifically indicated, for services received from Non-Participating Providers, subscribers will be responsible for all charges above the Allowable Amount in addition to the indicated Copayment or Coinsurance amount. Except as specifically provided herein, services are covered only when rendered by an individual or entity that is licensed or certified by the state to provide health care services and is operating within the scope of that license or certification. Allergy Testing and Treatment Benefits Benefits are provided for allergy testing and treatment, including allergy serum. Ambulance Benefits Benefits are provided for (1) ambulance services (ground and air) when used to transport a Member from place of illness or injury to the closest medical facility where appropriate treatment can be received; or (2) authorized ambulance transportation to or from Covered Services. Ambulatory Surgery Center Benefits Benefits are provided for surgery performed in an Ambulatory Surgery Center.