Common use of Transitional Care Clause in Contracts

Transitional Care. 1. The Parties must establish policies and procedures and develop a process describing how MCP and DMC-ODS will coordinate transitional care services for Members. A “transitional care service” is defined as the transfer of a Member from one setting or level of care to another, including, but not limited to, discharges from hospitals, institutions, and other acute care facilities and skilled nursing facilities to home- or community-based settings,2 level of care transitions that occur within the facility, or transitions from outpatient therapy to intensive outpatient therapy and vice versa. 2. For Members who are admitted for residential SUD treatment, including, but not limited to, Short-Term Residential Therapeutic Programs and Psychiatric Residential Treatment Facilities where DMC-ODS is the primary payer, DMC-ODS is primarily responsible for coordination of the Member upon discharge. In collaboration with DMC-ODS, MCP is responsible for ensuring transitional care coordination as required by Population Health Management,3 including, but not limited to: 2 Expectations for transitional care are defined in the PHM Policy Program Guide: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023-PHM-Program-Guide-a11y.pdf 3 Expectations for transitional care are defined in the PHM Policy Program Guide: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023-PHM-Program-Guide-a11y.pdf; see also PHM Roadmap and Strategy: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/Final-Population-Health- Management-Strategy-and-Roadmap.pdf a. Tracking when Members are admitted, discharged, or transferred from facilities contracted by DMC-ODS in accordance with Section 11(a)(iii) of this MOU; b. Approving prior authorizations and coordinating services where MCP is the primary payer (e.g., home services, long-term services, and supports for dual-eligible Members); c. Ensuring the completion of a discharge risk assessment and developing a discharge planning document; d. Assessing Members for any additional care management programs or services for which they may qualify, such as ECM, CCM, or Community Supports, and enrolling the Member in the program as appropriate; e. Notifying existing CCM Care Managers of any admission if the Member is already enrolled in ECM or CCM; and f. Assigning or contracting with a care manager to coordinate with county care coordinators to ensure physical health follow-up needs are met for each eligible Member as outlined by the Population Health Management Policy Guide.4 3. The Parties must include in their policies and procedures a process for updating and overseeing the implementation of the discharge planning documents as required for Members transitioning to or from MCP or DMC-ODS services; 4. For inpatient residential SUD treatment provided by DMC- ODS or for inpatient hospital admissions or emergency department visits known to MCP, the process must include the specific method to notify each Party within 24 hours of admission and discharge and the method of notification used to arrange for and coordinate appropriate follow-up services.

Transitional Care. 1. The Parties must establish policies and procedures and develop a process describing how MCP and DMC-ODS will coordinate transitional care services for Members. A “transitional care service” is defined as the transfer of a Member from one setting or level of care to another, including, but not limited to, discharges from hospitals, institutions, and other acute care facilities and skilled nursing facilities to home- or community-based settings,2 level of care transitions that occur within the facility, or transitions from outpatient therapy to intensive outpatient therapy and vice versa. 2. For Members who are admitted for residential SUD treatment, including, but not limited to, Short-Term Residential Therapeutic Programs and Psychiatric Residential Treatment Facilities where DMC-ODS is the primary payer, DMC-ODS is primarily responsible for coordination of the Member upon discharge. In collaboration with DMC-ODS, MCP is responsible for ensuring transitional care coordination as required by Population Health Management,3 including, but not limited to: : a. Tracking when Members are admitted, discharged, or transferred from facilities contracted by DMC-ODS in accordance with Section 11(a)(iii) of this MOU; 2 Expectations for transitional care are defined in the PHM Policy Program Guide: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023-PHM-Program-Guide-a11y.pdf 3 Expectations for transitional care are defined in the PHM Policy Program Guide: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023-PHM-Program-Guide-a11y.pdf; see also PHM Roadmap and Strategy: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/Final-Population-Health- Management-Strategy-and-Roadmap.pdf a. Tracking when Members are admitted, discharged, or transferred from facilities contracted by DMCManagement-Strategy-and-Roadmap.pdf DocuSign Envelope ID: 06E8AB6B-ODS in accordance with Section 11(a)(iii) of this MOU;BDBE-4700-B94F-1CF4AC89D0CC b. Approving prior authorizations and coordinating services where MCP is the primary payer (e.g., home services, long-term services, and supports for dual-eligible Members); c. Ensuring the completion of a discharge risk assessment and developing a discharge planning document; d. Assessing Members for any additional care management programs or services for which they may qualify, such as ECM, CCM, or Community Supports, and enrolling the Member in the program as appropriate; e. Notifying existing CCM Care Managers of any admission if the Member is already enrolled in ECM or CCM; and f. Assigning or contracting with a care manager to coordinate with county care coordinators to ensure physical health follow-up needs are met for each eligible Member as outlined by the Population Health Management Policy Guide.4 3. The Parties must include in their policies and procedures a process for updating and overseeing the implementation of the discharge planning documents as required for Members transitioning to or from MCP or DMC-ODS services; 4. For inpatient residential SUD treatment provided by DMC- ODS or for inpatient hospital admissions or emergency department visits known to MCP, the process must include the specific method to notify each Party within 24 hours of admission and discharge and the method of notification used to arrange for and coordinate appropriate follow-up services.

Transitional Care. 1. The Parties must establish policies and procedures and develop a process describing how MCP and DMC-ODS will coordinate transitional care services for Members. A “transitional care service” is defined as the transfer of a Member from one setting or level of care to another, including, but not limited to, discharges from hospitals, institutions, and other acute care facilities and skilled nursing facilities to home- or community-based settings,2 level of care transitions that occur within the facility, or transitions from outpatient therapy to intensive outpatient therapy and vice versa. 2. For Members who are admitted for residential SUD treatment, including, but not limited to, Short-Term Residential Therapeutic Programs and Psychiatric Residential Treatment Facilities where DMC-ODS is the primary payer, DMC-ODS is primarily responsible for coordination of the Member upon discharge. In collaboration with DMC-ODS, MCP is responsible for ensuring transitional care coordination as required by Population Health Management,3 including, but not limited to: : a. Tracking when Members are admitted, discharged, or transferred from facilities contracted by DMC-ODS in accordance with Section 11(a)(iii) of this MOU; 2 Expectations for transitional care are defined in the PHM Policy Program Guide: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023-PHM-Program-Guide-a11y.pdf 3 Expectations for transitional care are defined in the PHM Policy Program Guide: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023-PHM-Program-Guide-a11y.pdf; see also PHM Roadmap and Strategy: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/Final-Population-Health- Management-Strategy-and-Roadmap.pdf a. Tracking when Members are admitted, discharged, or transferred from facilities contracted by DMC-ODS in accordance with Section 11(a)(iii) of this MOU; b. Approving prior authorizations and coordinating services where MCP is the primary payer (e.g., home services, long-term services, and supports for dual-eligible Members); c. Ensuring the completion of a discharge risk assessment and developing a discharge planning document; d. Assessing Members for any additional care management programs or services for which they may qualify, such as ECM, CCM, or Community Supports, and enrolling the Member in the program as appropriate; e. Notifying existing CCM Care Managers of any admission if the Member is already enrolled in ECM or CCM; and f. Assigning or contracting with a care manager to coordinate with county care coordinators to ensure physical health follow-up needs are met for each eligible Member as outlined by the Population Health Management Policy Guide.4 3. The Parties must include in their policies and procedures a process for updating and overseeing the implementation of the discharge planning documents as required for Members transitioning to or from MCP or DMC-ODS services; 4. For inpatient residential SUD treatment provided by DMC- ODS or for inpatient hospital admissions or emergency department visits known to MCP, the process must include the specific method to notify each Party within 24 hours of admission and discharge and the method of notification used to arrange for and coordinate appropriate follow-up services.

Transitional Care. 1. The Parties must establish policies and procedures and develop a process describing how MCP and DMC-ODS will coordinate transitional care services for Members. A “transitional care service” is defined as the transfer of a Member from one setting or level of care to another, including, but not limited to, discharges from hospitals, institutions, and other acute care facilities and skilled nursing facilities to home- or community-based settings,2 level of care transitions that occur within the facility, or transitions from outpatient therapy to intensive outpatient therapy and vice versa. 2. For Members who are admitted for residential SUD treatment, including, but not limited to, Short-Term Residential Therapeutic Programs and Psychiatric Residential Treatment Facilities where DMC-ODS is the primary payer, DMC-ODS is primarily responsible for coordination of the Member upon discharge. In collaboration with DMC-ODS, MCP is responsible for ensuring transitional care coordination as required by Population Health Management,3 including, but not limited to: : a. Tracking when Members are admitted, discharged, or transferred from facilities contracted by DMC-ODS in accordance with Section 11(a)(iii) of this MOU; b. Approving prior authorizations and coordinating services where MCP is the primary payer (e.g., home services, long-term services, and supports for dual-eligible Members); 2 Expectations for transitional care are defined in the PHM Policy Program Guide: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023-PHM-Program-Guide-a11y.pdf 3 Expectations for transitional care are defined in the PHM Policy Program Guide: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023-PHM-Program-Guide-a11y.pdf; see also PHM Roadmap and Strategy: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/Final-Population-Health- Management-Strategy-and-Roadmap.pdfPopulation- Health-Management-Strategy-and-Roadmap.pdf a. Tracking when Members are admitted, discharged, or transferred from facilities contracted by DMC-ODS in accordance with Section 11(a)(iii) of this MOU; b. c. Approving prior authorizations and coordinating services where MCP is the primary payer (e.g., home services, long-term services, and supports for dual-eligible Members); c. d. Ensuring the completion of a discharge risk assessment and developing a discharge planning document; d. e. Assessing Members for any additional care management programs or services for which they may qualify, such as ECM, CCM, or Community Supports, and enrolling the Member in the program as appropriate; e. f. Notifying existing CCM Care Managers of any admission if the Member is already enrolled in ECM or CCM; and f. g. Assigning or contracting with a care manager to coordinate with county care coordinators to ensure physical health follow-up needs are met for each eligible Member as outlined by the Population Health Management Policy Guide.4 3. The Parties must include in their policies and procedures a process for updating and overseeing the implementation of the discharge planning documents as required for Members transitioning to or from MCP or DMC-ODS services; 4. For inpatient residential SUD treatment provided by DMC- ODS or for inpatient hospital admissions or emergency department visits known to MCP, the process must include the specific method to notify each Party within 24 hours of admission and discharge and the method of notification used to arrange for and coordinate appropriate follow-up services.

Transitional Care. 1. The Parties must establish policies and procedures and develop a process describing how MCP and DMC-ODS will coordinate transitional care services for Members. A “transitional care service” is defined as the transfer of a Member from one setting or level of care to another, including, but not limited to, discharges from hospitals, institutions, and other acute care facilities and skilled nursing facilities to home- or community-based settings,2 level of care transitions that occur within the facility, or transitions from outpatient therapy to intensive outpatient therapy and vice versa. 2. For Members who are admitted for residential SUD treatment, including, but not limited to, Short-Term Residential Therapeutic Programs and Psychiatric Residential Treatment Facilities where DMC-ODS is the primary payer, DMC-ODS is primarily responsible for coordination of the Member upon discharge. In collaboration with DMC-ODS, MCP is responsible for ensuring transitional care coordination as required by Population Health Management,3 including, but not limited to: : a. Tracking when Members are admitted, discharged, or transferred from facilities contracted by DMC-ODS in accordance with Section 11(a)(iii) of this MOU; 2 Expectations for transitional care are defined in the PHM Policy Program Guide: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023-PHM-Program-Guide-a11y.pdf 3 Expectations for transitional care are defined in the PHM Policy Program Guide: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023-PHM-Program-Guide-a11y.pdf; see also PHM Roadmap and Strategy: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/Final-Population-Health- Management-Strategy-and-Roadmap.pdf a. Tracking when Members are admitted, discharged, or transferred from facilities contracted by DMC-ODS in accordance with Section 11(a)(iii) of this MOU; b. Approving prior authorizations and coordinating services where MCP is the primary payer (e.g., home services, long-term services, and supports for dual-eligible Members); c. Ensuring the completion of a discharge risk assessment and developing a discharge planning document; d. Assessing Members for any additional care management programs or services for which they may qualify, such as ECM, CCM, or Community Supports, and enrolling the Member in the program as appropriate; e. Notifying existing CCM Care Managers of any admission if the Member is already enrolled in ECM or CCM; and f. Assigning or contracting with a care manager to coordinate with county care coordinators to ensure physical health follow-up needs are met for each eligible Member as outlined by the Population Health Management Policy Guide.4 3. The Parties must include in their policies and procedures a process for updating and overseeing the implementation of the discharge planning documents as required for Members transitioning to or from MCP or DMC-ODS services; 4. For inpatient residential SUD treatment provided by DMC- ODS or for inpatient hospital admissions or emergency department visits known to MCP, the process must include the specific method to notify each Party within 24 hours of admission and discharge and the method of notification used to arrange for and coordinate appropriate follow-up services.

Transitional Care. 1. The Parties must establish policies and procedures and develop a process describing how MCP and DMC-ODS will coordinate transitional care services for Members. A “transitional care service” is defined as the transfer of a Member from one setting or level of care to another, including, but not limited to, discharges from hospitals, institutions, and other acute care facilities and skilled nursing facilities to home- or community-based settings,2 level of care transitions that occur within the facility, or transitions from outpatient therapy to intensive outpatient therapy and vice versa. 2. For Members who are admitted for residential SUD treatment, including, but not limited to, Short-Term Residential Therapeutic Programs and Psychiatric Residential Treatment Facilities where DMC-ODS is the primary payer, DMC-ODS is primarily responsible for coordination of the Member upon discharge. In collaboration with DMC-ODS, MCP is responsible for ensuring transitional care coordination as required by Population Health Management,3 including, but not limited to: : a. Tracking when Members are admitted, discharged, or transferred from facilities contracted by DMC-ODS in accordance with Section 11(a)(iii) of this MOU; 2 Expectations for transitional care are defined in the PHM Policy Program Guide: 3 ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023-Documents/PHM-ProgramPolicy-Guide-a11y.pdf Guide.pdf 3 Expectations for transitional care are defined in the PHM Policy Program Guide: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023-Documents/PHM-ProgramPolicy-Guide-a11y.pdf; Guide.pdf see also PHM Roadmap and Strategy: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/Final-Population-Health- Management-Strategy-and-Roadmap.pdf a. Tracking when Members are admitted, discharged, or transferred from facilities contracted by DMCHealth-ODS in accordance with Section 11(a)(iii) of this MOU;Management-Strategy-and- Roadmap.pdf Docusign Envelope ID: F0807EFB-43F7-4245-B7BE-BF3615C8374B b. Approving prior authorizations and coordinating services where MCP is the primary payer (e.g., home services, long-term services, and supports for dual-eligible Members); c. Ensuring the completion of a discharge risk assessment and developing a discharge planning document; d. Assessing Members for any additional care management programs or services for which they may qualify, such as ECM, CCM, or Community Supports, and enrolling the Member in the program as appropriate; e. Notifying existing CCM Care Managers of any admission if the Member is already enrolled in ECM or CCM; and f. Assigning or contracting with a care manager to coordinate with county care coordinators to ensure physical health follow-up needs are met for each eligible Member as outlined by the Population Health Management Policy Guide.4 3. The Parties must include in their policies and procedures a process for updating and overseeing the implementation of the discharge planning documents as required for Members transitioning to or from MCP or DMC-ODS services; 4. For inpatient residential SUD treatment provided by DMC- ODS or for inpatient hospital admissions or emergency department visits known to MCP, the process must include the specific method to notify each Party within 24 hours of admission and discharge and the method of notification used to arrange for and coordinate appropriate follow-up services.

Transitional Care. 1. The Parties must establish policies and procedures and develop a process describing how MCP and DMC-ODS will coordinate transitional care services for Members. A “transitional care service” is defined as the transfer of a Member from one setting or level of care to another, including, but not limited to, discharges from hospitals, institutions, and other acute care facilities and skilled nursing facilities to home- or community-based settings,2 settings,1 level of care transitions that occur within the facility, or transitions from outpatient therapy to intensive outpatient therapy and vice versa. 2. For Members who are admitted for residential SUD treatment, including, but not limited to, Short-Term Residential Therapeutic Programs and Psychiatric Residential Treatment Facilities where DMC-ODS is the primary payer, DMC-ODS is primarily responsible for coordination of the Member upon discharge. In collaboration with DMC-ODS, MCP is responsible for ensuring transitional care coordination as required by Population Health Management,3 Management,2 including, but not limited to: 2 : a. Tracking when Members are admitted, discharged, or 1 Expectations for transitional care are defined in the PHM Policy Program Guide: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023-PHM-Program-Guide-a11y.pdf 3 2 Expectations for transitional care are defined in the PHM Policy Program Guide: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023-PHM-Program-Guide-a11y.pdf; see also PHM Roadmap and Strategy: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/Final-Population-Health- Management-Strategy-and-Roadmap.pdf a. Tracking when Members are admitted, discharged, or Management- Strategy-and-Roadmap.pdf transferred from facilities contracted by DMC-ODS in accordance with Section 11(a)(iii) of this MOU; b. Approving prior authorizations and coordinating services where MCP is the primary payer (e.g., home services, long-term services, and supports for dual-eligible Members); c. Ensuring the completion of a discharge risk assessment and developing a discharge planning document; d. Assessing Members for any additional care management programs or services for which they may qualify, such as ECM, CCM, or Community Supports, and enrolling the Member in the program as appropriate; e. Notifying existing CCM Care Managers of any admission if the Member is already enrolled in ECM or CCM; and f. Assigning or contracting with a care manager to coordinate with county care coordinators to ensure physical health follow-up needs are met for each eligible Member as outlined by the Population Health Management Policy Guide.4Guide.3 3. The Parties must include in their policies and procedures a process for updating and overseeing the implementation of the discharge planning documents as required for Members transitioning to or from MCP or DMC-ODS services; 4. For inpatient residential SUD treatment provided by DMC- ODS or for inpatient hospital admissions or emergency department visits known to MCP, the process must include the specific method to notify each Party within 24 hours of admission and discharge and the method of notification used to arrange for and coordinate appropriate follow-up services.