Full Delegation Model. In the Full Delegation Model, the CONTRACTOR is permitted to delegate the full set of Care Coordination functions to a Contract Provider (the delegate) for an attributable membership, and retains oversight and monitoring functions. The CONTRACTOR is only permitted to fully delegate Care Coordination when Care Coordination is included as part of a VBP arrangement(s) that outlines a payment arrangement for the full delegation of Care Coordination and other requirements associated with improving quality and health outcomes. The CONTRACTOR shall clearly define the terms of the VBP payment and Care Coordination delegation in order to fully delegate Care Coordination to the delegate for the attributed membership. The CONTRACTOR shall ensure the additional Care Coordination delegation requirements in VBP arrangements are met as described in the VBP delivery system improvement target in Attachment 2.A. The CONTRACTOR’s Care Coordination program description shall describe the CONTRACTOR’s roles and responsibilities in attributing membership and providing oversight and monitoring for its Full Delegation model. In establishing its Full Delegation model, the CONTRACTOR shall comply with the requirements in the Managed Care Policy Manual. Shared Functions Model In the Shared Functions Model, when offered, the CONTRACTOR retains some Care Coordination functions and allows other Care Coordination activities to be conducted by a delegated individual or entity. It does not require a VBP arrangement (although it may at the discretion of the CONTRACTOR and the delegated individual or entity). Potential shared Care Coordination functions may include the following: Conducting HRAs; Conducting CNAs; Conducting periodic touch points with Members as needed either in-person or telephonically; Coordinating referrals and linking Members to community services; Locating and engaging with Members categorized as CCL0; and Other functions as prior approved by HCA. The CONTRACTOR shall develop written agreements with individuals and entities that specify shared Care Coordination functions, reporting responsibilities, and a mutually-agreed upon reimbursement rate for shared functions of Care Coordination. The CONTRACTOR shall make good faith efforts to contract with tribal organizations (I/T/Us) for shared Care Coordination functions. The CONTRACTOR shall maintain all oversight and monitoring responsibilities for shared Care Coordination functions with the individuals and entities. The CON...
Full Delegation Model. In the Full Delegation Model, the CONTRACTOR delegates the full set of care coordination functions to the provider/health system (the delegate) for an attributable membership and only retains oversight and monitoring functions.
Full Delegation Model. In the Full Delegation Model, the CONTRACTOR is permitted to delegate the full set of Care Coordination functions to a Contract Provider (the delegate) for an attributable membership, and retains oversight and monitoring functions. The CONTRACTOR is only permitted to fully delegate Care Coordination when Care Coordination is included as part of a VBP arrangement(s) that outlines a payment arrangement for the full delegation of Care Coordination and other requirements associated with improving quality and health outcomes. The CONTRACTOR shall clearly define the terms of the VBP payment and Care Coordination delegation in order to fully delegate Care Coordination to the delegate for the attributed membership. The CONTRACTOR shall ensure the additional Care Coordination delegation requirements in VBP arrangements are met as described in the VBP delivery system improvement target in Attachment 2.A. The CONTRACTOR’s Care Coordination program description shall describe the CONTRACTOR’s roles and responsibilities in attributing membership and providing oversight and monitoring for its Full Delegation model. In establishing its Full Delegation model, the CONTRACTOR shall comply with the requirements in the Managed Care Policy Manual.
