Common use of Referral Process Clause in Contracts

Referral Process. The Parties must work collaboratively to develop and establish policies and procedures that ensure Members are referred to the appropriate MCP Covered Services and DMC State Plan County services. i. MCP must facilitate referrals to DMC State Plan County for Members who potentially meet the criteria to receive DMC State Plan County SUD services and ensure DMC State Plan County has procedures for accepting referrals from MCP. ii. MCP must refer Members using a patient-centered, shared decision- making process. iii. DMC State Plan County should assist MCP in identifying the appropriate DMC State Plan County program and/or services when assistance is required by MCP. iv. DMC State Plan County should refer Members to MCP for MCP's Covered Services, as well as any Community Supports services or care management programs for which Members may qualify, such as Enhanced Care Management ("ECM") or Complex Care Management ("CCM"). However, if DMC State Plan County is also an ECM Provider pursuant to a separate agreement between MCP and DMC State Plan County for ECM services, this MOU does not govern DMC State Plan County's provision of ECM services. v. The Parties must work collaboratively to ensure that Members may access services through multiple pathways. The Parties must ensure Members receive medically necessary SUD services; vi. MCP must have a process by which MCP accepts referrals from DMC State Plan County; vii. MCP must have a process to confirm that the referral was accepted by DMC State Plan County; viii. DMC State Plan County must have a process by which DMC State Plan County accepts referrals from MCP; ix. DMC State Plan County must have a process for communicating acceptance of the referral to MCP; and x. Closed Loop Referrals. By January 1, 2025 or otherwise determined by DHCS, the Parties must develop a process to implement DHCS guidance regarding closed loop referrals for applicable Community Supports, ECM benefits, and/or community-based resources, as referenced in the CalAIM Population Health Management Policy Guide1, APL 22-024, or any subsequent version of the APL, and as set forth by DHCS through an APL or other, similar guidance. The Parties must work collaboratively to develop and implement a process to ensure that MCP and DMC State Plan County comply with the applicable provisions of closed loop referrals guidance within 90 Working Days of issuance of this guidance. The Parties must establish a system that tracks cross-system referrals and meets all requirements as set forth by DHCS through an APL or other, similar guidance.

Referral Process. The Parties must work collaboratively to develop and establish policies and procedures that ensure Members are referred to the appropriate MCP MCPs’ Covered Services and DMC State Plan County services. i. MCP MCPs must facilitate referrals to DMC State Plan County for Members who potentially meet the criteria to receive DMC State Plan County SUD services and ensure DMC State Plan County has procedures for accepting referrals from MCPMCPs. ii. MCP MCPs must refer Members using a patient-centered, shared decision- decision-making process. iii. DMC State Plan County should assist MCP MCPs in identifying the appropriate DMC State Plan County program and/or services when assistance is required by MCPMCPs. iv. DMC State Plan County should refer Members to MCP MCPs for MCP's MCPs’ Covered Services, as well as any Community Supports services or care management programs for which Members may qualify, such as Enhanced Care Management ("“ECM"”) or Complex Care Management ("“CCM"”). However, if DMC State Plan County is also an ECM Provider pursuant to a separate agreement between MCP MCPs and DMC State Plan County for ECM services, this MOU does not govern DMC State Plan County's ’s provision of ECM services. v. The Parties must work collaboratively to ensure that Members may access services through multiple pathways. The Parties must ensure Members receive medically necessary SUD services; vi. MCP MCPs must have a process by which MCP MCPs accepts referrals from DMC State Plan County; vii. MCP MCPs must have a process to confirm that the referral was accepted by DMC State Plan County; viii. DMC State Plan County must have a process by which DMC State Plan County accepts referrals from MCP;MCPs; and ix. DMC State Plan County must have a process for communicating acceptance of the referral to MCP; andMCPs. x. Closed Loop Referrals. By January 1, 2025 2025, or otherwise determined future date set by DHCS, the Parties must develop a process to implement DHCS guidance regarding closed loop referrals for applicable Community Supports, ECM benefits, and/or community-based resources, as referenced in the CalAIM Population Health Management Policy Guide1, APL 22-024, or any subsequent version of the APL, and as set forth by DHCS through an APL or other, similar guidance. The Parties must work collaboratively to develop and implement a process to ensure that MCP and DMC State Plan County comply with the applicable provisions of closed loop referrals guidance within 90 Working Days of issuance of this guidance. The Parties must establish a system that tracks cross-system referrals and meets all requirements as set forth by DHCS through an APL or other, similar guidance.

Referral Process. The Parties must work collaboratively to develop and establish policies and procedures that ensure Members are referred to the appropriate MCP Covered Services and DMC State Plan County services. i. MCP must facilitate referrals to DMC State Plan County for Members who potentially meet the criteria to receive DMC State Plan County SUD services and ensure DMC State Plan County has procedures for accepting referrals from MCP. ii. MCP must refer Members using a patient-centered, shared decision- making process. iii. DMC State Plan County should assist MCP in identifying the appropriate DMC State Plan County program and/or services when assistance is required by MCP. iv. DMC State Plan County should refer Members to MCP for MCP's ’s Covered Services, as well as any Community Supports services or care management programs for which Members may qualify, such as Enhanced Care Management ("“ECM"”) or Complex Care Management ("“CCM"”). However, if DMC State Plan County is also an ECM Provider pursuant to a separate agreement between MCP and DMC State Plan County for ECM services, this MOU does not govern DMC State Plan County's ’s provision of ECM services. v. The Parties must work collaboratively to ensure that Members may access services through multiple pathways. The Parties must ensure Members receive medically necessary SUD services; vi. MCP must have a process by which MCP accepts referrals from DMC State Plan County; vii. MCP must have a process to confirm that the referral was accepted by DMC State Plan County; viii. DMC State Plan County must have a process by which DMC State Plan County accepts referrals from MCP;; and ix. DMC State Plan County must have a process for communicating acceptance of the referral to MCP; and x. Closed Loop Referrals. By January 1, 2025 or otherwise determined by DHCS, the Parties must develop a process to implement DHCS guidance regarding closed loop referrals for applicable Community Supports, ECM benefits, and/or community-based resources, as referenced in the CalAIM Population Health Management Policy Guide1, APL 22-024, or any subsequent version of the APL, and as set forth by DHCS through an APL or other, similar guidance. The Parties must work collaboratively to develop and implement a process to ensure that MCP and DMC State Plan County comply with the applicable provisions of closed loop referrals guidance within 90 Working Days of issuance of this guidance. The Parties must establish a system that tracks cross-system referrals and meets all requirements as set forth by DHCS through an APL or other, similar guidance.