Care Coordination. The Parties’ subcontract shall require that the Enrollee’s CP Care Coordinator provide ongoing care coordination support to the Enrollee in coordination with the Enrollee’s PCP and other providers as set forth in Section 2.6.
Care Coordination. MCOs must ensure care coordination is provided to Members with a substance use disorder. MCOs must work with providers, facilities, and Members to coordinate care for Members with a substance use disorder and to ensure Members have access to the full continuum of Covered Services (including without limitation assessment, detoxification, residential treatment, outpatient services, and medication therapy) as Medically Necessary and appropriate. MCOs must also coordinate services with the DSHS, DFPS, and their designees for Members requiring Non-Capitated Services. Non-Capitated Services includes, without limitation, services that are not available for coverage under the Contract, State Plan or Waiver that are available under the Federal Substance Abuse and Prevention and Treatment block grant when provided by a DSHS-funded provider or covered by the DFPS under direct contract with a treatment provider. MCOs must work with DSHS, DFPS, and providers to ensure payment for Covered Services is available to Out-of-Network Providers who also provide related Non-capitated Services when the Covered Services are not available through Network Providers.
Care Coordination. Required expectations for care coordination in the context of a care management plan shall include, but not be limited to:
Care Coordination. Prior to Contract start date and on an annual basis, the Contractor shall submit for approval to the State a Care Coordination Operational Plan. The Contractor must receive approval before member stratification. The operational plan shall include, but not limited to, the following: care coordination team member roles, care coordination team organizational chart, team member training requirements, team member educational and/or experience requirements, screening tool, stratification methodology (including, caseload ratios per stratification level), reassessment frequency, and care plan components. The Contractor’s care coordination operational plan and service delivery must contain evidence of person- centered practices in all aspects. In addition, the care coordination plan may be modified if the Contractor receives written approval from FSSA. The Contractor shall implement a transition of care policy that is consistent with federal requirements and at least meets the State-defined transition of care policies in the MCE Policies and Procedures Manual per 42 CFR 438.62(b)(1)-(2). In accordance with 42 CFR 438.208(b)(2)(i)-(iv) and 42 CFR 438.208(b)(4), the Contractor shall implement procedures to coordinate: ▪ Services the Contractor furnishes to the member between settings of care, including appropriate discharge planning for short-term and long-term hospital and institutional stays; ▪ Services the Contractor furnishes to the member with the services the member receives from any other MCE or health plan; ▪ Services the Contractor furnishes to the member with the services the member receives in FFS Medicaid; ▪ Services the Contractor furnishes to the member with the services the member receives from community and social support providers; and ▪ Sharing results of any identification of member needs from assessments with the State or other health plans.
Care Coordination. Care coordination is defined as the organized delivery of member care activities between two (2) or more participants (including the member) involved in a member’s care to facilitate the appropriate delivery of health care services. Organizing care involves the marshaling of personnel and other resources needed to carry out all medically necessary member care activities and is often managed by the exchange of information among participants responsible for different aspects of care.
Care Coordination. The Contractor shall offer Care Coordination and case management services to all Enrollees, as described in Welfare and Institutions Code sections 14182.17(d)(4) and 14186(b).
Care Coordination. 2.5.4.1. The Contractor shall offer care coordination to all Enrollees:
Care Coordination. Contractor shall coordinate and work collaboratively with MSSP providers on care coordination activities surrounding the MSSP Waiver Participant including, but not limited to: coordination of benefits between Contractor and MSSP provider to avoid duplication of services and coordinate Care Management activities particularly at the point of discharge from the MSSP.
Care Coordination. A process used by a person or team to assist Enrollees in accessing Medicare and Medicaid services, as well as social, educational, and other support services, regardless of the funding source for the services. It is characterized by advocacy, communication, and resource management to promote quality, cost effectiveness and positive outcomes.
Care Coordination. 6.4.1. The Contractor shall provide care coordination for its Members, necessary for the Members to achieve their desired health outcomes in an efficient and responsible manner. The Contractor may allow the PCMPs, other Subcontractors or other sources to perform some or all of the care coordination activities, but the Contractor shall be responsible for the ultimate delivery of care coordination services.
