Coordinated Care Plan. A. The Medicare Advantage Organization agrees to operate one or more coordinated care plans as defined in 42 CFR 422.4(a)(l)(iii)), including at least one MA-PD plan as required under 42 CFR 422.4(c), as described in its final Plan Benefit Package (PBP) bid submission (benefit and price bid) proposal as approved by CMS and as attested to in the Medicare Advantage Attestation of Benefit Plan and Price, and in compliance with the requirements of this contract and applicable Federal statutes, regulations, and policies.
Coordinated Care Plan. The Medicare+Choice Organization agrees to operate coordinated care plans (as defined in 42 CFR 422.4(a)(l)), as described in its Adjusted Community Rate (ACR) proposal as approved annually by CMS, in compliance with the requirements of this contract and applicable Federal statutes, regulations, and policies. This contract is deemed to incorporate any changes that are required by statute to be implemented during the term of the contract and any regulations or policies implementing or interpreting such statutory provisions. However, CMS agrees that any regulation or policy statement it issues later than 30 days prior to the date by which M+C Organizations are required to submit ACR proposals to CMS, and which creates significant new operational costs of which the M+C Organization did not have reasonable notice prior to such date, shall not take effect in the next calendar year unless implementation during the next calendar year is required by statute or in connection with litigation challenging CMS' policies. CMS retains the authority to issue, with an effective date during the term of this contract, policies to implement the statutory requirement that M+C Organizations provide their enrollees those items and services for which benefits are available under Medicare Parts A and B. Clarifications or explanations of M+C operational requirements issued prior to 30 days prior to the date by which M+C Organizations are required to submit ACR proposals are not considered to create new operational costs of which the M+C organization did not have notice.
Coordinated Care Plan. A. The Medicare Advantage Organization agrees to operate one or more coordinated care plans as defined in 42 CFR 422.4(a)(1)(iii)), including at least one MA-PD plan as required under 42 CFR 422.4(c), as described in its final Plan Benefit Package (PBP) bid submission (benefit and price bid) proposal as approved by CMS and as attested to in the Medicare Advantage Attestation of Benefit Plan and Price, and in compliance with the requirements of this contract and applicable Federal statutes, regulations, and policies. B. Except as provided in paragraph (C) of this Article, this contract is deemed to incorporate any changes that are required by statute to be implemented during the term of the contract and any regulations or policies implementing or interpreting such statutory provisions. C. CMS will not implement, other than at the beginning of a calendar year, requirements under 42 CFR Part 422 that impose a new significant cost or burden on MA organizations or plans, unless a different effective date is required by statute. [422.521] Article III Functions To Be Performed By Medicare Advantage Organization A. PROVISION OF BENEFITS 1. The MA Organization agrees to provide enrollees in each of its MA plans the basic benefits as required under §422.101 and, to the extent applicable, supplemental benefits under §422.102 and as established in the MA Organization’s final benefit and price bid proposal as approved by CMS and listed in the MA Organization Plan Attestation of Benefit Plan and Price, which is attached to this contract. The MA Organization agrees to provide access to such benefits as 2 required under subpart C in a manner consistent with professionally recognized standards of health care and according to the access standards stated in §422.112.
Coordinated Care Plan. The LTC Home will identify all patients (residents) with complex care needs for which a coordinated care plan would support the patient journey. Coordinated Care Planning can be led by the LTC Home and/or in collaboration with other system partners and providers. The LTC Home will collect and report data on the number of identified patients for a Coordinated Care Plan to the LHIN on a quarterly basis. Drive Quality and Value Improve the Patient Experience Initiatives to reduce caregiver stress and improve transitions between care settings, Patient and Family Advisory Committee(s) engagement. Patient Experience and Patient Confidence Measurement: The LTC Home will work with the LHIN to evaluate opportunities to adopt patient confidence and patient experience indicators as required by the Integrated Regional Quality Plan. The LTC Home will participate in the deployment of patient confidence measures aligned to sub region development. Accreditation: LTC Homes are required to maintain accreditation on an ongoing basis and provide proof of accreditation to the LHIN when accreditation is awarded. Demonstrate System Leadership Home and Community Care Working with the ministry and Ontario Palliative Care Network to expand timely access to coordinated and high quality palliative and end of life care. Palliative Care The LTC Home will participate fully in the Central West Palliative Care Network and will consult and collaborate with the Network prior to making any material adjustments (additions/deletions or enhancements) to Palliative care services. The LTC Home will implement Palliative Care Network recommendations and support other palliative care initiatives, as required. Strengthen a Palliative Care approach for residents and families in LTCH to improve care experience and improve utilization of the health care system, as evidenced by a decreased utilization of Emergency Departments by LTCH residents and a decreased number of residents dying in acute care. Schedule E – Form of Compliance Declaration DECLARATION OF COMPLIANCE Issued pursuant to the Long Term Care Service Accountability Agreement
Coordinated Care Plan. The Medicare+Choice Organization agrees to operate coordinated care plans (as defined in 42 CFR Section 422.4(a)(1)) as described in Attachment D to this contract in compliance with the requirements of this contract and applicable Federal statutes, regulations, and policies. This contract is deemed to incorporate any changes that are required by statute to be implemented during the term of the contract and any regulations or policies implementing or interpreting such statutory provisions. However, any regulations or policy statements issued by HCFA after July 1, 2000 for which implementation during the contract year is not required by statute or in connection with litigation challenging HCFA policies, and which create significant new operational costs of which the M+C Organization did not have reasonable notice prior to such date, shall not become effective before January 1, 2002. HCFA retains the authority to issue, with an effective date during the term of this contract, policies to implement the statutory requirement that M+C Organizations provide their enrollees those items and services for which benefits are available under Medicare Parts A and B. Clarifications or explanations of M+C operational requirements issued prior to July 1, 2000 are not considered to create new operational costs of which the M+C organization did not have notice.
Coordinated Care Plan. A. The Medicare+Choice Organization agrees to operate the following coordinated care plans (as defined in 42 CFR Section 422.4(a)(1)) in compliance with the requirements of this contract, and the Federal statutes, regulations, and rules applicable to the Medicare+Choice program:
Coordinated Care Plan. A. The MA Organization agrees to operate one or more coordinated care plans as defined in 42 CFR §422.4(a)(l)(iii)), including at least one MA-PD plan as required under 42 CFR §422.4(c), as described in its final Plan Benefit Package (PBP) bid submission (benefit and price bid) proposal as approved by CMS and as attested to in the Medicare Advantage Attestation of Benefit Plan and Price, and in compliance with the requirements of this contract and applicable Federal statutes, regulations, and policies (e.g., policies as described in the Call Letter, Medicare Managed Care Manual, etc.).
