Education of Providers, including, but not limited to, clinically appropriate guidelines and Enrollee-specific information with respect to an Enrollee’s disease or condition, including relevant indicators; and The Care Management activities described in Section 2.5.E. Establish such affiliations with providers (including Community Service Agencies (CSAs) in the Contractor’s geographic area, as determined by EOHHS) and organizations as necessary to fulfil the requirements of this Section, including affiliations with Community Partners and other community-based organizations and social services organizations; Ensure appropriate care for Enrollees with Special Health Care Needs; Make best efforts to minimize boarding of Enrollees in emergency departments as follows: The Contractor shall ensure timely access to medically necessary, clinically appropriate behavioral health services for Enrollees determined by EOHHS to be disproportionately boarded in emergency departments, including, but not limited to, Enrollees with: Autism Spectrum Disorder (ASD); Intellectual or Developmental Disabilities (IDD); Dual diagnosis of mental health and substance use disorder; Co-morbid medical conditions; and Assaultive or combative presentation resulting in the need for special accommodation in an inpatient psychiatric hospital setting; and In accordance with Appendix A, the Contractor shall report to EOHHS on any Enrollee awaiting placement in a 24-hour level of behavioral health care who remains in an emergency department for 24 hours or longer, as further specified by EOHHS; Care Needs Screening and Appropriate Follow-Up The Contractor shall ensure that Enrollees receive screenings to identify their health and functional needs as follows: The Contractor shall develop, implement, and maintain procedures for completing an initial Care Needs Screening for each Enrollee, and shall make best efforts to complete such screening within 90 days of the Enrollee’s Effective Date of Enrollment;
Education of Providers, including, but not limited to, clinically appropriate guidelines and Enrollee-specific information with respect to an Enrollee’s disease or condition, including relevant indicators; and The Care Management activities described in Section 2.5.E. Establish such affiliations with providers (including Community Service Agencies (CSAs) in the Contractor’s geographic area, as determined by EOHHS) and organizations as necessary to fulfil the requirements of this Section, including affiliations with Community Partners and other community-based organizations and social services organizations; Ensure appropriate care for Enrollees with Special Health Care Needs; Make best efforts to minimize boarding of Enrollees in emergency departments as follows: The Contractor shall ensure timely access to medically necessary, clinically appropriate behavioral health services for Enrollees determined by EOHHS to be disproportionately boarded in emergency departments, including, but not limited to, Enrollees with: Autism Spectrum Disorder (ASD); Intellectual or Developmental Disabilities (IDD); Dual diagnosis of mental health and substance use disorder; Co-morbid medical conditions; and Assaultive or combative presentation resulting in the need for special accommodation in an inpatient psychiatric hospital setting; and In accordance with Appendix A, the Contractor shall report to EOHHS on any Enrollee awaiting placement in a 24-hour level of behavioral health care who remains in an emergency department for 24 hours or longer, as further specified by EOHHS; Care Needs Screening and Appropriate Follow-Up The Contractor shall ensure that Enrollees receive screenings to identify their health and functional needs as follows: The Contractor shall develop, implement, and maintain procedures for completing an initial Care Needs Screening for each Enrollee, and shall make best efforts to complete such screening within 90 days of the Enrollee’s Effective Date of Enrollment;
accountable-care-partnership-plan-model-contract.docx