Common use of Transitional Care Clause in Contracts

Transitional Care. 1. The Parties must establish policies and procedures and develop a process describing how MCPs and DMC State Plan County will coordinate transitional care services for Members. A “transitional care service” is defined as the transfer of a Member from one setting or level of care to another, including, but not limited to, discharges from hospitals, institutions, and other acute care facilities and skilled nursing facilities to home- or community-based settings,1 level of care transitions that occur within the facility, or transitions from outpatient therapy to intensive outpatient therapy and vice versa. 2. Members who are admitted for residential SUD treatment, including Perinatal Residential Substance Use Disorder Treatment and residential SUD treatment provided to Members under the age of 21 pursuant to the EPSDT benefit mandate where DMC State Plan County is the primary payer, DMC State Plan County is primarily responsible for coordination of the Member upon discharge. In collaboration with DMC State Plan County, MCPs are responsible for ensuring transitional care coordination as required by Population Health Management,2 including, but not limited to: a. Tracking when Members are admitted, discharged, or transferred from facilities contracted by DMC State Plan County in accordance with Section 11(a)(iii) of this MOU; b. Approving prior authorizations and coordinating services where MCPs is the primary payer (e.g., home services, long-term services, and supports for dual-eligible Members); c. Ensuring the completion of a discharge risk assessment and developing a discharge planning document; d. Assessing Members for any additional care management programs or services for which they may qualify, such as ECM, CCM, or Community Supports, and enrolling the Member in the program as appropriate; e. Notifying existing CCM Care Managers of any admission if the Member is already enrolled in ECM or CCM; and f. Assigning or contracting with a care manager to coordinate with county care coordinators to ensure physical health follow-up needs are met for each eligible Member as outlined by the Population Health Management Policy Guide.3 3. The Parties must include in their policies and procedures a process for updating and overseeing the implementation of the discharge planning documents as required for Members transitioning to or from MCPs or DMC State Plan services; 4. For inpatient residential SUD treatment provided by DMC State Plan County or for inpatient hospital admissions or emergency department visits known to MCPs, the process must include the specific method to notify each Party within 24 hours of admission and discharge and the method of notification used to arrange for and coordinate appropriate follow-up services.

Transitional Care. 1. The Parties must establish policies and procedures and develop a process describing how MCPs MCP and DMC State Plan County will coordinate transitional care services for Members. A “transitional care service” is defined as the transfer of a Member from one setting or level of care to another, including, but not limited to, discharges from hospitals, institutions, and other acute care facilities and skilled nursing facilities to home- or community-based settings,1 level of care transitions that occur within the facility, or transitions from outpatient therapy to intensive outpatient therapy and vice versa. 2. Members who are admitted for residential SUD treatment, including Perinatal Residential Substance Use Disorder Treatment and residential SUD treatment provided to Members under the age of 21 pursuant to the EPSDT benefit mandate where DMC State Plan County is the primary payer, DMC State Plan County is primarily responsible for coordination of the Member upon discharge. In collaboration with DMC State Plan County, MCPs are MCP is responsible for ensuring transitional care coordination as required by Population Health Management,2 including, but not limited to: a. Tracking when Members are admitted, discharged, or transferred from facilities contracted by DMC State Plan County in accordance with Section 11(a)(iii) of this MOU; b. Approving prior authorizations and coordinating services where MCPs MCP is the primary payer (e.g., home services, long-term services, and supports for dual-eligible Members); c. Ensuring the completion of a discharge risk assessment and developing a discharge planning document; d. Assessing Members for any additional care management programs or services for which they may qualify, such as ECM, CCM, or Community Supports, and enrolling the Member in the program as appropriate; e. Notifying existing CCM Care Managers of any admission if the Member is already enrolled in ECM or CCM; and f. Assigning or contracting with a care manager to coordinate with county care coordinators to ensure physical health follow-up needs are met for each eligible Member as outlined by the Population Health Management Policy Guide.3Guide.3 1 Expectations for transitional care are defined in the Population Health Management Policy Program Guide: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/PHM-Policy-Guide.pdf‌ 2 The Population Health Management Policy Program Guide can be found here: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/PHM-Policy-Guide.pdf; see also PHM Roadmap and Strategy: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/Final-Population-Health- Management-Strategy-and-Roadmap.pdf 3 CalAIM Population Health Management Policy Guide available at ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/PHM-Policy-Guide.pdf. 3. The Parties must include in their policies and procedures a process for updating and overseeing the implementation of the discharge planning documents as required for Members transitioning to or from MCPs MCP or DMC State Plan services; 4. For inpatient residential SUD treatment provided by DMC State Plan County or for inpatient hospital admissions or emergency department visits known to MCPsMCP, the process must include the specific method to notify each Party within 24 hours of admission and discharge and the method of notification used to arrange for and coordinate appropriate follow-up services.

Transitional Care. 1. The Parties must establish policies and procedures and develop a process describing how MCPs MCP and DMC State Plan County will coordinate transitional care services for Members. A “"transitional care service” " is defined as the transfer of a Member from one setting or level of care to another, including, but not limited to, discharges from hospitals, institutions, and other acute care facilities and skilled nursing facilities to home- or community-based settings,1 settings, 1 level of care transitions that occur within the facility, or transitions from outpatient therapy to intensive outpatient therapy and vice versa. 2. For Members who are admitted for residential SUD treatment, including Perinatal Residential Substance Use Disorder Treatment and residential SUD treatment provided to Members under the age of 21 pursuant to the EPSDT benefit mandate where DMC State Plan County is the primary payer, DMC State Plan County is primarily responsible for coordination of the Member upon discharge. In collaboration with DMC State Plan County, MCPs are MCP is responsible for ensuring transitional care coordination as required by Population Health Management,2 including, but not limited to: a. Tracking when Members are admitted, discharged, or transferred from facilities contracted by DMC State Plan County in accordance with Section 11(a)(iii) of this MOU; b. Approving prior authorizations and coordinating services where MCPs MCP is the primary payer (e.g., home services, long-term services, and supports for dual-eligible Members); c. Ensuring the completion of a discharge risk assessment and developing a discharge planning document; d. Assessing Members for any additional care management programs or services for which they may qualify, such as ECM, CCM, or Community Supports, and enrolling the Member in the program as appropriateasappropriate; e. Notifying existing CCM Care Managers of any admission if the Member is already enrolled in ECM or CCM; and f. Assigning or contracting with a care manager to coordinate with county care coordinators to ensure physical health follow-up needs are met for each eligible Member as outlined by the Population Health Management Policy Guide.3Guide.3 1 Expectations for transitional care are defined in the Population Health Management Policy Program Guide: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/PHM-Policy-Guide.pdf 2 The Population Health Management Policy Program Guide can be found here: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/PHM-Policy-Guide.pdf; see also PHM Roadmap and Strategy: ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/Final-Population-Health-Management-Strategy-and-Roadmap.pdf 3 CalAIM Population Health Management Policy Guide available at ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/PHM-Policy-Guide.pdf. 3. The Parties must include in their policies and procedures a process for updating and overseeing the implementation of the discharge planning documents as required for Members transitioning to or from MCPs MCP or DMC State Plan services; 4. For inpatient residential SUD treatment provided by DMC State Plan County or for inpatient hospital admissions or emergency department visits known to MCPsMCP, the process must include the specific method to notify each Party within 24 hours of admission and discharge and the method of notification used to arrange for and coordinate appropriate follow-up services.