Care Coordination and Collaboration Clause Samples

Care Coordination and Collaboration a. MCP and LHD must coordinate to ensure Members receiving services through MCAH Programs have access to prevention and wellness information and services. LHD is encouraged to assist Members with accessing prevention and wellness services covered by MCP, by sharing resources and information to with Members about services for which they are eligible, to address needs identified by MCAH Programs’ assessments. b. MCP must screen Members for eligibility for care management programs such as CCM and ECM, and must, as needed, provide care management services for Members enrolled in MCAH Programs, including for comprehensive perinatal services, high-risk pregnancies, and children with special health care needs. MCP must engage LHD, as needed, for care management and care coordination. c. MCP should collaborate with MCAH Programs on perinatal provider technical support and communication regarding perinatal issues and service delivery and to monitor the quality of care coordination. 17 CDPH, Local MCAH Programs Policies and Procedures, available at: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/Programs/CFH/DMCAH/LocalMCAH/CDPH%20Document%20Library/ MCAH-Policies-and-Procedures.pdf 18 CDPH, Local MCAH Programs Policies and Procedures, available at ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/Programs/CFH/DMCAH/LocalMCAH/CDPH%20Document%20Library/ MCAH-Policies-and-Procedures.pdf DocuSign Envelope ID: F79290DD-ECCE-476E-A29A-E6F42D469B6D

Care Coordination and Collaboration. In addition to the Care Coordination and Collaboration outlined in Section 9 - Care Coordination and Collaboration of the MOU, the Parties will comply with the following:

Care Coordination and Collaboration a. The Parties must adopt policies and procedures for coordinating Members’ access to care and services that incorporate all the requirements set forth in this MOU, including those in the applicable Program Exhibits. b. The Parties must discuss and address individual care coordination issues or barriers to care coordination efforts at least quarterly. c. MCP must have policies and procedures in place to maintain cross-system collaboration with HCA and to identify strategies to monitor and assess the effectiveness of this MOU. d. The Parties will comply with care coordination and collaboration outlined in the Program Exhibits. Notwithstanding any other parts of this MOU, including its Program Exhibits, the Parties may not disclose any information in their possession that is subject to 42 C.F.R. Part 2 unless such disclosure is permitted under 42 C.F.R. Part 2.

Care Coordination and Collaboration a. Care Coordination. 1 CalAIM Population Health Management Policy Guide, available at ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023‐PHM‐Policy‐Guide.pdf. i. The Parties must adopt policies and procedures for coordinating Members’ access to care and services that incorporate all the requirements set forth in this MOU. ii. The Parties must discuss and address individual care coordination issues or barriers to care coordination efforts at least quarterly. iii. MCP must have policies and procedures in place to maintain cross- system collaboration with DMC-ODS and to identify strategies to monitor and assess the effectiveness of this MOU. iv. The Parties must implement policies and procedures that align for coordinating Members’ care that address: 1. The requirement for DMC-ODS to refer Members to MCP to be assessed for care coordination and other similar programs and other services for which they may qualify provided by MCP including, but not limited to, ECM, CCM, or Community Supports; 2. The specific point of contact from each Party, if someone other than each Party’s Responsible Person, to act as the liaison between Parties and be responsible for initiating, providing, and maintaining ongoing care coordination for all Members under this MOU; 3. A process for how MCP and DMC-ODS will engage in collaborative treatment planning to ensure care is clinically appropriate and non- duplicative and considers the Member’s established therapeutic relationships; 4. A process for coordinating the delivery of Medically Necessary Covered Services with the Member’s Primary Care Provider, including without limitation transportation services, home health services, and other Medically Necessary Covered Services for eligible Members; 5. A process for how MCP and DMC-ODS will help to ensure the Member is engaged and participates in their care program and a process for ensuring the Members, caregivers, and providers are engaged in the development of the Member’s care; 6. A process for reviewing and updating a Member’s problem list, as clinically indicated. The process must describe circumstances for updating problem lists and coordinating with outpatient SUD providers; 7. A process for how the Parties will engage in collaborative treatment planning and ensure communication among providers, including procedures for exchanges of medical information; and 8. Processes to ensure that Members and providers can coordinate coverage of Covered Services and carved-out services outlined b...

Care Coordination and Collaboration a) HPSM and Other Party must coordinate to ensure Members receiving services through MCAH Programs have access to prevention and wellness information and services. Other Party is encouraged to assist Members with accessing prevention and wellness services covered by HPSM, by sharing resources and information to with Members about services for which they are eligible, to address needs identified by MCAH Programs’ assessments. b) HPSM must screen Members for eligibility for care management programs such as CCM and ECM, and must, as needed, provide care management services for Members enrolled in MCAH Programs, including for comprehensive perinatal services, high-risk pregnancies, and children with special health care needs. HPSM must engage Other Party, as needed, for care management and care coordination. c) HPSM should collaborate with MCAH Programs on perinatal provider technical support and communication regarding perinatal issues and service delivery and to monitor the quality-of- care coordination

Care Coordination and Collaboration a. The Parties must adopt policies and procedures for coordinating Members’ access to care and services that incorporate all the requirements set forth in this MOU. b. The Parties must discuss and address systematic and, to the extent possible, individual care coordination issues or barriers to care coordination efforts at least quarterly. c. MCP must have policies and procedures in place to maintain collaboration with First 5 and to identify strategies to monitor and assess the effectiveness of this MOU d. When a Member enrolled in ECM also receives First 5 Services, the ECM Provider shall coordinate services with First 5 (as appropriate) or First 5 Providers to ensure the Member’s needs are addressed. To support the ECM Provider, MCP must ensure that the Member’s ECM Providers are aware of First 5 agencies and contacts and consult with, keep informed (as appropriate), and share data with (as appropriate) First 5 or the First 5 Provider that provides First 5 Services to the Member.

Care Coordination and Collaboration a) The Parties must adopt policies and procedures for coordinating Members’ access to care and services that incorporate all the requirements set forth in this MOU, including those in the applicable Program Exhibits. b) The Parties must discuss and address individual care coordination issues or barriers to care coordination efforts at least quarterly. c) HPSM must have policies and procedures in place to maintain collaboration with Other Party and to identify strategies to monitor and assess the effectiveness of this MOU. The HPSM and Other Party will comply with care coordination and collaboration outlined in the Program Exhibits. d) The HPSM and Other Party will comply with care coordination and collaboration outlined in the Program Exhibits. Docusign Envelope ID: D704F5A3-1FAF-499F-B725-E1CD5B84B766

Care Coordination and Collaboration