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 MHP/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;1 for DMC-ODS, level of care transitions that occur within the facility; or transitions from outpatient therapy to intensive outpatient therapy and vice versa. 2. For MHP Members who are admitted to an acute psychiatric hospital, psychiatric health facility, adult residential, or crisis residential stay, or DMC-ODS Members who are admitted for residential SUD treatment, including, but not limited to, Short- Term Residential Therapeutic Programs and Psychiatric Residential Treatment Facilities, where MHP/DMC-ODS is the primary payer, MHP/DMC-ODS are primarily responsible for coordination of the Member upon discharge. In collaboration with MHP/DMC-ODS, MCP is responsible for ensuring transitional care coordination as required by Population Health Management,2 including, but not limited to: a. Tracking when Members are admitted, discharged, or transferred from facilities contracted by MHP/DMC-ODS (e.g., psychiatric inpatient hospitals, psychiatric health facilities, residential mental health facilities) 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 behavioral health or county care coordinators for each eligible Member to ensure physical health follow up needs are met as outlined by the Population Health 1 Expectations for transitional care are defined in the PHM Policy Program Guide: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023-PHM-Program-Guide-a11y.pdf 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 Management Policy Guide. 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 MHP/DMC-ODS services. 4. For inpatient mental health treatment provided by MHP or 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. 5. For MHP only, the Parties must have policies and procedures for addressing changes in a member’s medical or mental health condition when transferring between inpatient psychiatric service and inpatient medical services, including direct transfers.