Integration of Care Clause Samples

The Integration of Care clause establishes a framework for coordinating and unifying the various healthcare services provided to a patient. In practice, this clause typically requires all involved healthcare providers—such as physicians, specialists, and therapists—to share relevant information and collaborate on treatment plans to ensure consistency and continuity of care. By mandating such cooperation, the clause helps prevent gaps, redundancies, or conflicting treatments, ultimately improving patient outcomes and streamlining the delivery of healthcare services.
Integration of Care. This component of the evaluation must test the following hypotheses as they relate to both populations affected by the integration projects: 1) Did this care model provide the same or an improved level of physical and behavioral health care quality as non-integrated care model? Health care quality includes improved access, utilization, health care outcomes and patient experience. 2) Did this care model improve how physical and behavioral health is integrated for the target population in a way that is different than the care they would have received if they had remained in the traditional care model? The baseline period, as reflected in the revised evaluation design, must include information detailing the characteristics of the fragmented delivery system that is being replaced with the integrated system of care, such as the prevalence of multiple care plans, the number of primary care provider not connected with case managers, the number of duplicated tests and/or treatment, and the number of beneficiaries making and keeping appointments post discharge.
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Integration of Care. I is hereby amended by deleting it in its entirety and replacing it with the following:- “During Contract Year 2018, the Contractor shall partner with EOHHS to develop and execute a transition plan for MBHP members including but not limited to ICMP and PBCM Members who are identified by EOHHS for future enrollment in an ACO or CP. This plan shall include but not be limited to, Member-specific transitional “handoff” meetings between MBHP (including ICMP/PBCM members) and ACOs or CPs.”
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Integration of Care. A. Project case managers are responsible for long-term care planning and at least annual assessments, for developing and carrying out strategies to coordinate and integrate the delivery of all acute and long-term care services to enrollees. B. For those persons enrolled in the contractor's Medicare Advantage plan (where applicable), the contractor must have protocols to ensure that all acute care services and long-term care services are coordinated. The enrollee's case manager must coordinate with the primary care physician, as well as the enrollee or other appropriate person, in the development of acute and long-term care plans. The contractor must ensure that all subcontractors, delivering services covered by the contract, agree to cooperate with the goal of an integrated and coordinated service delivery system for the enrollee. Amendment 001 Agreement Number XQ744 C. When contract enrollees elect to remain in the Medicare fee-for-service system, the contractor must establish protocols to ensure that services are coordinated to the maximum extent feasible. The case manager must actively pursue coordination with the enrollee's primary care physician and other care providers. D. In addition, the contractor will be responsible for the following activities to facilitate care coordination and continuity of care: 1. The contractor must implement a systematic process for generating or receiving referrals and with the enrollee's written consent, sharing clinical and treatment plan information, including management of medications. 2. The contractor must implement a systematic process for obtaining consent from enrollees or their representatives to share confidential medical and treatment-planning information with providers. 3. The contractor must implement a systematic process for coordinating care with organizations which are not part of the contractor's network of providers but are otherwise important to the health and well being of enrollees. 4. For enrollees in an assisted living or nursing facility, the contractor will ensure coordination with the medical, nursing, or administrative staff designated by the facility to ensure that the enrollees have timely and appropriate access to the contractor's providers and to coordinate care between those providers and the facility's providers. 5. The contractor must implement a systematic process for tracking the Medicaid eligibility redetermination dates on a monthly basis to ensure continuity of care without a break ...
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Integration of Care. H is hereby amended by deleting it in its entirety and replacing it with the following:
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Integration of Care. A is hereby amended by deleting it in its entirety and replacing it with the following language:
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Integration of Care. A. Project case managers are responsible for long-term care planning and for developing and carrying out strategies to coordinate and integrate the delivery of all acute and long-term care services to enrollees. B. For those persons enrolled in the contractor's Medicare+Choice plan (where applicable), the contractor must have protocols to ensure that all acute care services and services are coordinated. The enrollee's case manager must coordinate with the primary care physician, as well as the enrollee or other appropriate person, in the development of acute and long-term care plans. The contractor must ensure that all subcontractors, delivering services covered by the contract, agree to cooperate with the goal of an integrated and coordinated service delivery system for the enrollee. C. When contract enrollees elect to remain in the Medicare fee-for-service system, the contractor must establish protocols to ensure that services are coordinated to the maximum extent feasible. The case manager must actively pursue coordination with the enrollee's primary care physician and other care providers. Attachment I- 32 of 55 Contract No. ▇▇▇▇-▇▇▇▇-▇▇ D. In addition, the contractor will be responsible for the following activities to facilitate care coordination: 1. The contractor must implement a systematic process for generating or receiving referrals and, with the enrollee's written consent, sharing clinical and treatment plan information, including management of medications.
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Integration of Care. Coordinated and unified treatment of health concerns across the physical and behavioral health spectrum.
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Related to Integration of Care

  • 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. 7.2. CONTRACTOR shall ensure that care coordination activities support the monitoring and treatment of comorbid substance use disorder and/or health conditions. 7.3. CONTRACTOR shall include in care coordination activities efforts to connect, refer and link clients to community-based services and supports, including but not limited to educational, social, prevocational, vocational, housing, nutritional, criminal justice, transportation, childcare, child development, family/marriage education, cultural sources, and mutual aid support groups. 7.4. CONTRACTOR shall engage in care coordination activities beginning at intake and throughout the treatment and discharge planning processes. 7.5. To facilitate care coordination, CONTRACTOR will request a HIPAA and California law compliant client authorization to share client information with and among all other providers involved in the client’s care, in satisfaction of state and federal privacy laws and regulations.

  • Collection of card When your application is approved by us, we may send you the card, and a renewal or replacement thereof, by ordinary post to the address we have on record for you. In the event you fail to receive the card and unauthorized transactions occur on the card account, you will not be liable for the balances arising therefrom provided you have not acted fraudulently or negligently. We are not liable to you for any loss or damage which you may suffer if you fail to receive the card.

  • Continuity of Care OMPP is committed to providing continuity of care for members as they transition between various IHCP programs and the Contractor’s enrollment. The Contractor shall have mechanisms in place to ensure the continuity of care and coordination of medically necessary health care services for its Hoosier Healthwise members. The State emphasizes several critically important areas where the Contractor shall address continuity of care. Critical continuity of care areas include, but are not limited to:  Transitions for members receiving HIV, Hepatitis C and/or behavioral health services, especially for those members who have received prior authorization from their previous MCE or through fee-for-service;  Transitions for members who are pregnant;  A member’s transition into the Hoosier Healthwise program from traditional fee-for- service or HIP;  A member’s transition between MCEs, particularly during an inpatient stay;  A member’s transition between IHCP programs, Members exiting the Hoosier Healthwise program to receive excluded services;  A member’s exiting the Hoosier Healthwise program to receive excluded services;  A member’s transition to a new PMP;  A member’s transition to private insurance or Marketplace coverage; and  A member’s transition to no coverage. In situations such as a member or PMP disenrollment, the Contractor shall facilitate care coordination with other MCEs or other PMPs. When receiving members from another MCE or fee-for-service, the Contractor shall honor the previous care authorizations for a minimum of thirty (30) calendar days from the member’s date of enrollment with the Contractor. Contractor shall establish policies and procedures for identifying outstanding prior authorization decisions at the time of the member’s enrollment in their plan. For purposes of clarification, the date of member enrollment for purposes of the prior authorization time frames set forth in this section begin on the date the Contractor receives the member’s fully eligible file from the State. Additionally, when a member transitions to another source of coverage, the Contractor shall be responsible for providing the receiving entity with information on any current service authorizations, utilization data and other applicable clinical information such as disease management, case management or care management notes. This process shall be overseen by the Transition Coordination Manager. The Contractor will be responsible for care coordination after the member has disenrolled from the Contractor whenever the member disenrollment occurs during an inpatient stay. In these cases, the Contractor will remain financially responsible for the hospital DRG payment and any outlier payments (without a capitation payment) until the member is discharged from the hospital or the member’s eligibility in Medicaid terminates. The Contractor shall coordinate discharge plans with the member’s new MCE. See Section 3.7.5 for additional requirements regarding continuity of care for behavioral health services. The Hoosier Healthwise MCE Policies and Procedures Manual describes the Contractor’s continuity and coordination of care responsibilities in more detail.

  • Selection of Carrier The selection of the insurance carrier and policy shall be made by the School District as provided by law.

  • QUALITY OF CARE (a) The PHP shall assure that any and all eligible beneficiaries receive partial hospitalization services which comply with standards in Article 3.3