Patient Centered Primary Care Sample Clauses

Patient Centered Primary Care. Contractor shall develop and use PCPCH and other patient-centered primary care approaches to achieve the goals of Health System Transformation. In this connection, Contractor shall: (1) Contract with a network of PCPCHs recognized under Oregon’s standards (OAR 409- 055-0000 to 0090). Contractor shall provide: (a) Assurances that the Contractor enrolls a significant percentage of Members in PCPCHs certified as Tier 1 or higher according to Oregon’s standards; and (b) A concrete plan for increasing the number of enrollees served by certified PCPCHs over the first five years of operation, including targets and benchmarks; and (c) A concrete plan for Tier 1 PCPCHs to move toward Tier 2 and 3 of the Oregon standard over the first five years of operation, including targets and benchmarks. (2) Require Contractor’s other contracting health and services providers to communicate and coordinate care with the PCPCH in a timely manner using electronic health information technology, where available. (3) Ensure that Members of all communities in its Service Area receive integrated, culturally and linguistically appropriate person-centered care and services, and that Members are fully informed partners in transitioning to and maximizing the benefits of this model of care. (4) Encourage the use of FQHCs, rural health clinics, school-based health clinics and other safety net Providers that qualify as PCPCHs to ensure the continued critical role of those Providers in meeting the health of underserved populations.

Patient Centered Primary Care. Contractor shall develop and use PCPCH and other patient-centered primary care approaches to achieve the goals of Health System Transformation. In this connection, Contractor shall: (1) Contract with a network of PCPCHs recognized under Oregon’s standards. Contractor shall provide: (a) Assurances that the Contractor enrolls a significant percentage of Members in PCPCHs certified as Tier 1 or higher according to Oregon’s standards; and (b) A concrete plan for increasing the number of enrollees served by certified PCPCHs over the first five years of operation, including targets and benchmarks; and (c) A concrete plan for Tier 1 PCPCHs to move toward Tier 2 and 3 of the Oregon standard over the first five years of operation, including targets and benchmarks. (2) Require Contractor’s other contracting health and services providers to communicate and coordinate care with the PCPCH in a timely manner using electronic health information technology, where available. (3) Ensure that Members of all communities in its Service Area receive integrated, culturally and linguistically appropriate person-centered care and services, and that Members are fully informed partners in transitioning to and maximizing the benefits of this model of care. (4) Encourage the use of FQHCs, rural health clinics, school-based health clinics and other safety net Providers that qualify as PCPCHs to ensure the continued critical role of those Providers in meeting the health of underserved populations.

Patient Centered Primary Care. Homes (PCPCH). a. RAE shall fully participate in TCMC collaborative efforts to further develop the “health home” model in both physician health and behavioral health settings. b. Exhibit B, Part 4, Section 9 of the Core Contract shall be Delegated to RAE; Section 9.c and 9.d excepted. ▇. ▇▇▇ shall provide a report to TCMC that includes the following: (i) number of health care teams or clinics meeting PCPCH standards, by tier; (ii) number of primary care Practitioners accepting Members in a PCPCH listed out by tier 1, 2 or 3; (iii) number of Members assigned to Providers in PCPCH practices listed out by tier 1, 2 or 3; and (iv) number of Members with chronic conditions, as described in the CMS approved State Plan Amendment, listed out by tier 1, 2 or 3. ▇. ▇▇▇ is participating in Comprehensive Primary Care Initiative (CPC Initiative) consistent with their MOU with CMS. There is no additional funding for this Initiative beyond the capitated payment outlined in Exhibit C of this Agreement.

Patient Centered Primary Care. Homes (PCPCH) a. Contractor shall include in its network, to the greatest extent possible, Patient-Centered Primary Care Homes as identified by OHA. Contractor shall develop and assist in advancing Providers along the spectrum of the PCPCH model (from Tier 1 to Tier 5). Contractor shall assist Providers within its delivery system to establish PCPCHs. b. In addition to Provider reporting requirements described in OARs, Contractor shall provide a report to OHA Contract Administration Unit, no later than 30 days following the end of each quarter, to include all Members that are assigned to a PCPCH Provider listed out by tier 1, 2, 3, 4 or 5. Contractor shall coordinate with each PCPCH Provider in developing these lists. c. Contractor shall require its Providers to communicate and coordinate care with the PCPCH in a timely manner using electronic health information technology to the maximum extent feasible. d. Contractor shall develop and use PCPCH and other patient-centered primary care approaches to achieve the goals of Health System Transformation. e. In this connection, Contractor shall contract with a network of PCPCHs recognized under Oregon’s standards (OAR 409-055-0000 to 0090). Contractor shall provide: (a) A work plan for increasing the number of enrollees served by certified PCPCHs over the first five years of operation, including targets and benchmarks; and

Patient Centered Primary Care. Homes (PCPCH) a. When CMS has approved Oregon’s PPACA SPA, OHA will provide Contractor payments in addition to capitation, for Members with chronic conditions (as defined in Oregon’s Medicaid state Plan Amendment 2703 and as specified in OAR ▇▇▇-▇▇▇-▇▇▇▇) (“ACA Qualifying Conditions”) consistent with CMS approval. For Members that have ACA qualifying conditions, Contractor shall provide enhanced or additional reimbursement for PCPCH services and should reflect the PCPCH Tier level achieved, consistent with CMS approvals. b. If Contractor retains any portion of the PCPCH case rate payment for individuals with ACA Qualifying conditions and does not pass the entire payment to the Provider, Contractor shall use that portion to carry out functions related to PCPCH and is subject to approval by OHA. c. In addition to Provider reporting requirements described in OARs, Contractor shall provide a report to OHA on a monthly basis to include all Members with chronic conditions, as described in the CMS approved State Plan amendment, that are assigned to a PCPCH Provider listed out by tier 1, 2 or 3. Contractor should work with each PCPCH Provider in developing these lists. d. Contractor shall provide a report to OHA that includes the following: (1) Number of health care teams or clinics meeting PCPCH standards, by tier. (2) Number of primary care Practitioners accepting Members in a PCPCH listed out by tier 1, 2 or 3. (3) Number of Members assigned to Providers in PCPCH practices listed out by tier 1, 2 or 3. (4) Number of Members with chronic conditions, as described in the CMS approved State Plan Amendment, listed out by tier 1, 2 or 3. e. Contractor shall promote and assist other Providers to communicate and coordinate care with the PCPCH in a timely manner using electronic health information technology to the maximum extent feasible. f. The payment methodology and reporting requirements contained in this section will be revisited and are subject to amendment effective October, 2013.