Behavioral Health Continuity of Care Sample Clauses

Behavioral Health Continuity of Care. The Contractor shall utilize behavioral health case managers to monitor the care of members receiving behavioral health services who are new to the Contractor or who are transitioning to another MCE or other treatment provider, to ensure that medical records, treatment plans and other pertinent medical information follows each transitioning member. The Contractor shall notify the receiving MCE or other provider of the member’s previous behavioral health treatment, and shall offer to provide to the new provider the member’s treatment plan, if available, and consultation with the member’s previous treating provider. The Contractor and receiving MCE shall coordinate information regarding prior authorized services for members in transition. The Contractor shall require, through provider contract provisions, that members receiving inpatient psychiatric services are scheduled for outpatient follow-up and/or continuing treatment prior to discharge. This treatment shall be provided within seven (7) calendar days from the date of the member’s discharge. If a member misses an outpatient follow-up or continuing treatment, the Contractor shall ensure that a behavioral health care provider or the Contractor’s behavioral health case manager contacts that member within three (3) business days of notification of the missed appointment.
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Behavioral Health Continuity of Care. The Contractor must monitor the care of a member receiving behavioral health services who is new to the Contractor or who is transitioning to another managed care entity (MCE) or other treatment provider, to ensure that medical records, treatment plans and other pertinent medical information follows the transitioning member. The Contractor must notify the receiving MCE or other provider of the member’s previous behavioral health treatment, and must offer to provide to the new provider the member’s treatment plan, if available, and consultation with the member’s previous treating provider. The Contractor and receiving MCE must coordinate information regarding prior authorized services for members in transition in accordance with Section 3.15. The Contractor must ensure there is adequate discharge planning for members hospitalized for a behavioral health condition. Members must not be discharged to homelessness. The Contractor shall coordinate with hospital discharge planners and CMHC case managers (if the member is receiving case management through a CMHC). The Contractor must require, through provider agreement provisions, that members receiving inpatient psychiatric services are scheduled for outpatient follow-up and/or continuing treatment prior to discharge. The Contractor shall make every effort to ensure treatment is provided within seven (7) calendar days from the date of the member’s discharge. If a member misses an outpatient follow-up or continuing treatment, the Contractor must ensure that a behavioral health care provider or the Contractor’s behavioral health case manager contacts that member within three (3) business days of the missed appointment. The State is exploring implementation of new initiatives for behavioral health integration for Indiana Medicaid members that is expected to result in a higher level of integration of services. The Contractor shall provide enhanced care coordination at the direction of the State as a result of these initiatives.
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Behavioral Health Continuity of Care. The Contractor shall utilize behavioral health case managers to monitor the care of members receiving behavioral health services who are new to the Contractor or who are transitioning to another MCE or other treatment provider, to ensure that medical records, treatment plans and other pertinent medical information follows each transitioning member. The Contractor shall notify the receiving MCE or other provider of the member’s previous behavioral health treatment, and shall offer to provide to the new provider the member’s treatment plan, if available, and consultation with the member’s previous treating provider. The Contractor and receiving MCE shall coordinate information regarding prior authorized services for members in transition. The Contractor shall require, through provider contract provisions, that members receiving inpatient psychiatric services are scheduled for outpatient follow-up and/or continuing treatment prior to discharge. This treatment shall be provided within seven
Sample 1Sample 2Sample 3See All (8)
Behavioral Health Continuity of Care. The Contractor must monitor the care of a member receiving behavioral health services who is new to the Contractor or who is transitioning to another managed care entity (MCE) or other treatment provider, to ensure that medical records, treatment plans and other pertinent medical information follows the transitioning member. The Contractor must notify the receiving MCE or other provider of the member’s previous behavioral health treatment, and must offer to provide to the new provider the member’s treatment plan, if available, and consultation with the member’s previous treating provider. The Contractor and receiving MCE must coordinate information regarding prior authorized services for members in transition in accordance with Section 3.15. The Contractor must ensure there is adequate discharge planning for members hospitalized for a behavioral health condition. Respondents shall explain how they will coordinate with hospital discharge planners and CMHC case managers (if the member is receiving case management through a CMHC). T he Contractor must require, through provider agreement provisions, that members receiving inpatient psychiatric services are scheduled for outpatient follow-up and/or continuing treatment prior to discharge. This treatment must be provided within seven (7) calendar days from the date of the member’s discharge. If a member misses an outpatient follow-up or continuing treatment, the Contractor must ensure that a behavioral health care provider or the Contractor’s behavioral health case manager contacts that member within three (3) business days of the missed appointment.
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Behavioral Health Continuity of Care. The Contractor must monitor the care of a member receiving behavioral health services who is new to the Contractor or who is transitioning to another managed care entity (MCE) or other treatment provider, to ensure that medical records, treatment plans and other pertinent medical information follows the transitioning member. The Contractor
Sample 1Sample 2
Behavioral Health Continuity of Care. The Contractor shall utilize behavioral health case managers to monitor the care of members receiving behavioral health services who are new to the Contractor or who are transitioning to another MCE or other treatment provider, to ensure that medical records, treatment plans and other pertinent medical information follows each transitioning member. The Contractor shall notify the receiving MCE or other provider of the previous treating provider. The Contractor and receiving MCE shall coordinate information regarding prior authorized services for members in transition. The Contractor shall require, through provider contract provisions, that members receiving inpatient psychiatric services are scheduled for outpatient follow-up and/or continuing treatment prior to discharge. This treatment shall be provided within seven (7) calendar d outpatient follow-up or continuing treatment, the Contractor shall ensure that a behavioral member within three (3) business days of notification of the missed appointment.
Sample 1

Related to Behavioral Health Continuity of Care

  • Behavioral Health Services Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. Inpatient This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. Residential Treatment Facility This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. Intermediate Care Services This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

  • Emergency Medical Care a. How to appropriately use Emergency Services and facilities, including a description of the services offered by the Member Services Call Center;

  • Community Mental Health Center Services Assertive Community Treatment Staffing Full Time Equivalents Community Mental Health Center June 2020 March 2020 Nurse Masters Level Clinician/or Equivalent Functional Support Worker Peer Specialist Total (Excluding Psychiatry) Psychiatrist/Nurse Practitioner Total (Excluding Psychiatry) Psychiatrist/Nurse Practitioner 01 Northern Human Services 1.81 1.80 9.75 0.00 13.36 1.20 16.37 1.20 02 West Central Behavioral Health 0.70 1.20 3.70 0.50 6.10 0.50 6.10 0.50 03 Lakes Region Mental Health Center 1.00 2.00 2.50 1.00 6.50 0.75 7.00 0.75 04 Riverbend Community Mental Health Center 0.50 2.00 8.00 0.00 10.50 0.50 10.50 0.50 05 Monadnock Family Services 2.00 2.25 3.50 1.10 8.85 0.65 8.85 0.65 06 Greater Nashua Mental Health 1 1.00 1.00 5.00 1.00 8.00 0.25 6.50 0.25 06 Greater Nashua Mental Health 2 1.00 1.00 5.00 1.00 8.00 0.25 7.50 0.25 07 Mental Health Center of Greater Manchester-CTT 1.00 11.00 5.25 1.00 18.25 0.91 18.25 0.91 07 Mental Health Center of Greater Manchester-MCST 1.00 8.00 7.25 1.00 17.25 0.91 16.25 0.91 08 Seacoast Mental Health Center 1.00 2.10 5.00 1.00 9.10 0.60 9.10 0.60 09 Community Partners 0.25 2.00 6.95 0.00 9.20 0.70 11.05 0.63 10 Center for Life Management 1.00 2.00 4.30 1.00 8.30 0.40 8.55 0.40 Total 12.26 36.35 66.20 8.60 123.41 7.62 127.02 7.55 2b. Community Mental Health Center Services: Assertive Community Treatment Staffing Competencies Community Mental Health Center Substance Use Disorder Treatment Housing Assistance Supported Employment June 2020 March 2020 June 2020 March 2020 June 2020 March 2020 01 Northern Human Services 3.55 2.55 8.75 10.75 1.00 1.50 02 West Central Behavioral Health 0.20 0.20 4.10 4.10 0.60 0.60 03 Lakes Region Mental Health Center 1.00 1.00 5.50 6.00 2.00 2.00 04 Riverbend Community Mental Health Center 1.50 1.50 9.50 9.50 0.50 0.50 05 Monadnock Family Services 1.40 1.40 2.00 2.00 1.00 1.00 06 Greater Nashua Mental Health 1 4.25 4.25 6.25 6.25 1.00 1.00 06 Greater Nashua Mental Health 2 5.25 5.25 7.00 7.00 0.00 0.00 07 Mental Health Center of Greater Manchester-CCT 10.91 10.91 13.75 13.75 2.00 2.00 07 Mental Health Center of Greater Manchester-MCST 5.91 5.91 12.75 11.75 2.00 2.00 08 Seacoast Mental Health Center 2.00 2.00 5.00 5.00 2.00 2.00 09 Community Partners 2.70 2.63 5.05 5.05 0.38 0.68 10 Center for Life Management 3.00 3.00 7.00 7.00 0.30 0.30 Total 41.67 40.60 86.65 88.15 12.78 14.58 Revisions to Prior Period: None. Data Source: Bureau of Mental Health CMHC ACT Staffing Census Based on CMHC self-report. Notes: Data compiled 07/16/2020; for 2b: the Staff Competency values reflect the sum of FTEs trained to provide each service type. These numbers are not a reflection of the services delivered, but rather the quantity of staff available to provide each service. If staff are trained to provide multiple service types, their entire FTE value is credited to each service type.

  • Outpatient emergency and urgicenter services within the service area The emergency room copay applies to all outpatient emergency visits that do not result in hospital admission within twenty-four (24) hours. The urgicenter copay is the same as the primary care clinic office visit copay.

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