Coordination of Care. (a) The MA Dual SNP is responsible for coordinating the delivery of all benefits covered by both Medicare and Medicaid for Dual Eligible Members and Other Dual SNP Members who are eligible for LTSS including when benefits are delivered via Medicaid fee-for-service, making reasonable efforts to coordinate Medicare Advantage benefits provided by the MA Dual SNP with LTSS provided through Texas Health and Human Services Commission and the STAR+PLUS HMOs. Coordination of Care must include the following for these members:
Coordination of Care. The PH-MCO must coordinate care for its Members. The PH-MCO must provide for seamless and continuous coordination of care across a continuum of services for the Member with a focus on improving health care outcomes. The continuum of services may include the In-Plan comprehensive service package, out-of-plan services, and non-MA covered services provided by other community resources such as: • Nursing Facility Care • Intermediate Care Facility for the Intellectually Disabled/Other Related Conditions • Residential Treatment Facility • Acute Psychiatric Facilities • Extended and Extended Acute Psychiatric Facilities • Non-Hospital Residential Detoxification, Rehabilitation, and Half- Way House Facilities for Drug/Alcohol Dependence/ Addiction • Opioid Use Disorder Centers of Excellence • Aging Well PA/Level of Care Assessment and Pre-admission Screening Requirements • Juvenile Detention Centers • Children in Substitute Care Transition • Adoption Assistance for Children and Adolescents • Services to Dual Eligibles Under the Age of Twenty-one • Transitional Care Homes • Medical Xxxxxx Care Services • Early Intervention Services (note the PH-MCO must refer for Early Intervention Services any of its Members who are children from birth to age three (3) who are living in residential facilities. “Children living in residential facilities” describes children who are in a 24-hour living setting in which care is provided for one or more children.) • The OBRA waiver, a home-and-community-based waiver program for individuals who have a severe developmental physical disability requiring an Intermediate Care Facility/Other Related Conditions (ICF/ORC) level of care • Intellectual Disabilities Services (note the PH-MCO is responsible to ensure a family with a child who has or is at risk of a developmental delay is referred to the County Intellectual Disabilities office for a determination of eligibility for home and community-based services, including children living in residential facilities as described above.) • Home-and Community-Based Waiver for Persons with Intellectual Disabilities • Children in Residential Facilities • Home-and Community-Based Waiver for Persons with Autism The PH-MCO must provide the necessary related services for Members in facilities as described in Exhibit O, Description of Facilities and Related Services. Out-of-Plan Services are described in Exhibit P, Out-of-Plan Services. Recipient coverage rules are outlined in Exhibit BB, PH-MCO Recipient ...
Coordination of Care. 7.1. CONTRACTOR shall ensure that all care, treatment and services provided pursuant to this Agreement are coordinated among all providers who are serving the client, including all other SMHS providers, as well as providers of Non-Specialty Mental Health Services (NSMHS), substance use disorder treatment services, physical health services, dental services, regional center services and all other services as applicable to ensure a client-centered and whole- person approach to services.
Coordination of Care. A. The Contractor shall implement procedures to deliver care to and coordinate services for all of its beneficiaries. (42 C.F.R. § 438.208(b).) These procedures shall meet Department requirements and shall do the following:
Coordination of Care. Contractor shall provide coordination of care assistance to Prospective Enrollees to access a PCP or WHCP, or to continue a course of treatment, before Contractor’s coverage becomes effective, if requested to do so by Prospective Enrollees, or if Contractor has knowledge of the need for such assistance. The Care Coordinator assigned to the Prospective Enrollee shall attempt to contact the Prospective Enrollee no later than two (2) Business Days after the Care Coordinator is notified of the request for coordination of care.
Coordination of Care. 1. In addition to meeting the coordination and continuity of care requirements set forth in Article II.E.3, the Contractor shall develop a care coordination plan that provides for seamless transitions of care for beneficiaries with the DMC-ODS system of care. Contractor is responsible for developing a structured approach to care coordination to ensure that beneficiaries successfully transition between levels of SUD care (i.e. withdrawal management, residential, outpatient) without disruptions to services.
Coordination of Care. 1. To coordinate care and deliver quality health care to the MCO’s Enrollees by providing all necessary information to the Medicaid Program, its authorized agents, the Administrative Services Organizations with which the Department contracts and to any other entity as directed by the Department, in accordance with applicable federal and state confidentiality laws and regulations.
Coordination of Care. The Contractor will ensure coordination of care of all covered benefits under this Agreement including those provided for children, adolescents and adults for RIte Care, Rhody Health Partners and the Affordable Care Act Adult Expansion Populations. Coordination of care includes identification and follow-up of members with significant health and social needs that are at high risk of poor health outcomes, ensuring coordination of services and appropriate referral and follow-up. In particular, the Contractor will ensure coordination between medical services and behavioral health services required by the members. The Contractor will provide a care coordination program designed to help members who may or may not have a chronic disease, but have acute physical health, behavioral health, or social needs that impact health status and/or are at risk of further exacerbation of their illness. When the members need warrants immediate attention, care coordination will ensure access to primary care and behavioral health services. The goal of care coordination is to reduce the impact of any adverse outcome. Care coordination services are short term and time limited and should not be confused with intensive care management and/or other interventions. Services may include assistance with making or keeping needed medical or behavioral health appointments, hospital discharge planning, health coaching, and referrals related to the member’s immediate needs. Members are identified for care coordination because their needs do not meet the level of intensive care management as defined in this contract. The Contractor will develop guidelines for care coordination that will be submitted to EOHHS for review and approval. The Contract will have approval from the EOHHS for any subsequent changes prior to implementation of said changes. The Contractor will demonstrate the link to other Contractor systems such as quality, member services, utilization review, and appeals and grievances. For member who are identified as having special health care needs, the Contractor will: • Approve care plans in a timely manner if the Contractor’s approval is required. • Ensure that care plans are developed in accordance with applicable state quality assurance and utilization review standards. • Ensure that care plans are reviewed upon reassessment of functional need, at least every twelve (12) months, or when the member’s circumstances or needs change significantly, or at the request of the member. As ...
Coordination of Care. The Contractor must provider coordination of care to Individuals in with complex needs.
Coordination of Care. Provider hereby agrees to the following:
