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HomeMy WebLinkAboutC18-375 Rocky Mountain Health Plans Memorandum of Understanding Rocky Mountain Health Plans and Eagle County Government, a Healthy Communities Contractor in Region 1 This memorandum of understanding (“MOU”) is entered into as of _______________________ by and among Rocky Mountain Health Plans (“RMHP”), as the Regional Accountable Entity (“RAE”) for Region 1 in which Eagle County is located, and Eagle County Government, the organization that has contracted with the Colorado Department of Health Care Policy and Financing to operate the Healthy Communities program (the “HC contractor”) and are jointly referred to as the “Parties”. Purpose The goal of this MOU is to detail the obligations of each Party to improve the experience of Health First Colorado (Colorado’s Medicaid Program) Members (“HFC Member”) through seamless coordination between the HC contractor and RMHP. The Parties agree to work collaboratively to align and coordinate onboarding and outreach activities. In addition, the HC contractor and RMHP will align around key Health First Colorado priorities. Specifically, outreach from both Parties will seek to ensure: • Children and their parents are accessing regular well care including annual well visits for all ages, annual dental visits, and prenatal care. • HFC Members with behavioral health concerns are connected to and supported in accessing behavioral health services. • HFC Member in foster care will be referred for a behavioral health assessment. • Parents and children with substance use disorders are connected to substance use treatment. • HFC Members are informed that using emergency departments should be reserved for true emergencies, based upon the prudent layperson definition. RMHP’s Educational Responsibilities • RMHP will employ materials from the Colorado Department of Health Care Policy and Financing to inform Network Providers regarding the benefits of well-child care and Early and Periodic Screening, Diagnostic and Treatment (“EPSDT”), which is the child health component of Medicaid. • RMHP will provide training to the HC contractor regarding the Accountable Care Collaborative and RMHP’s unique interventions and processes. Coordinated Outreach / Onboarding Activities RMHP and the HC contractor have established a collective goal of reducing duplication around the onboarding process. To meet this goal: • RMHP will provide copies of pertinent member materials to the HC contractor, including but not limited to welcome letters, welcome call scripts, and care management letters that DocuSign Envelope ID: DACB5D12-B1CF-41A5-8334-DD0B157101D5 12/18/2018 RMHP sends to HFC Members. The HC contractor may use these materials in its outreach activities as it sees fit. • The Parties will work together to identify HFC Members that either Party believes that such Member could benefit from RMHP care coordination. • The HC contractor will identify gaps and communicate with RMHP to understand how RMHP can help it meet its unique regional needs and typical member-centric needs. • RMHP and the HC contractor will coordinate for outreach to mothers of newborn babies using a person-centered approach. RMHP and the HC contractor will also coordinate with other applicable organizations, such as Community Centered Boards, Family Resource Centers, Nurse-Family Partnership, and the Health Care Program for Children with Special Needs, as appropriate to the HFC Member. • RMHP will assist the HC contractor with connecting HFC Members to specialists in the RAE network, upon request of the HC contractor. RMHP and the HC contractor will coordinate with each other when needs arise, including, but not limited to the following: • Supporting Members with non-emergent transportation. • Supporting Members who are not able to see various providers • Educating Members about all Health First Colorado benefits available to them • Training providers regarding alternatives to dismissing Members from their practice (due to no-show appointments, etc.) • Community resource referrals • Bilingual staff who can communicate in a Member’s primary language Referral Criteria RMHP’s RAE Care Coordination Model is designed to address the needs of HFC Members across the spectrum, from basic needs related to accessing preventive care and services, to complex acute and chronic care needs related to physical health behavioral health and addressing social determinants. RMHP can receive referrals from HC contractors to do any of the following: • Person-centered care planning and collaborative SMART 1 goal setting • Assistance in finding a provider & appointment scheduling (including behavioral health) • Addressing social determinants of health • Health Neighborhood navigation • Navigation of health services and benefits • Communication facilitation between HFC Members, providers, community resources, and other systems like criminal justice • Periodic follow up as needed to address care plan goals 1 A SMART goal is defined as one that is specific, measurable, achievable, results-focused, and time-bound. DocuSign Envelope ID: DACB5D12-B1CF-41A5-8334-DD0B157101D5 • “Graduating” HFC Members from care coordination once SMART goals are met and Member is stable • Helping HFC Members to better understand their EPSDT benefits (see EPSDT section below for more details) Early and Periodic Screening, Diagnostic and Treatment (EPSDT) RMHP will partner with the HC contractor to improve access, education and awareness for eligible HFC Members regarding the comprehensive EPSDT benefit. The EPSDT benefit is exclusive to HFC Members. With respect to EPSDT, the HC contractor guides families through the process of obtaining both preventive (screening and diagnosis) and sick care/mitigation (treatment). The HC contractor does not provide any medical care and does not conduct the screening or provide other medical services directly. Regarding EPSDT referral provisions, the HC contractor may provide the following services: • Scheduling assistance for transportation • 60 day follow up for eligible HFC Members • Explanation of benefits and referral for providers • Assistance with food insecurity • Coordination with Women Infant Children programs, Nurse Family Partnership, Head Start, and other agencies • Focus on holistic support for the entire family, not just the child Regarding EPSDT referral provisions, RMHP care coordination and partners will provide: • Care coordination assistance as defined in the care coordination Referral Processes section of this MOU. See Referral Criteria section. Referral Processes A) Referrals from RMHP to HC Contractors: RMHP’s care coordination teams and HC contractor will work together at the local level to establish a process for understanding Eagle County’s resources and services provided by the HC contractor and its preferred method of receiving referrals. RMHP will refer to the Department of Health Care Policy and Financing website for HC contractor contact information when necessary. Current URL: https://www.colorado.gov/pacific/hcpf/family-health-coordinator-list B) Referrals from the HC Contractor to RMHP: • Call the RMHP Care Management (“CM”) referral line at 970-248-8718 and RMHP will identify the correct team to which the member should be referred * • Fax the referral to RMHP CM at: 800-972-5839 • Required information to include: o HFC Member Name o HFC Member DOB o Medicaid ID Number o Reason for the referral DocuSign Envelope ID: DACB5D12-B1CF-41A5-8334-DD0B157101D5 o Healthy Communities Coordinator Name o Healthy Communities Coordinator contact information o HFC Member’s valid contact information • Optional information to include: o Turnaround time you gave the Member for an outreach call o HFC Member’s Primary Care Medical Provider o Copy of assessments o Specific member-centric needs and history o Parent’s name o Guardian’s name o Is this a foster family?  Name of the Eagle County Department of Human Services (“ECDHS”) Case Manager  ECDHS Case Manager contact information * If HC contractor has a relationship with an Integrated Community Care Team (“ICCT”), it may communicate with the ICCT, instead of sending the referral to RMHP. Data Sharing • The HC Contract Manager at the Department of Health Care Policy and Finance will share RAE Region 1 HC contractors' data logs with RMHP on a regular basis, including a member level log of all contacts made and what occurred during that contact (at a high level). • On a quarterly basis, RMHP will provide the HC contractor with linkages to sites with information about well child care use, prenatal care use, dental care use, emergency department visits, and behavioral health engagement in Eagle County, Colorado. Meeting Facilitation and Attendance RMHP will facilitate region-wide meetings on a quarterly basis and be responsive to ad hoc meeting requests by the HC contractor. At least one representative from the HC contractor will attend the quarterly meetings unless there are extenuating circumstances. Term of Agreement • Term of MOU. This MOU shall commence on the first day written above, and shall continue full-force and effect for twelve months unless terminated or cancelled prior to the expiration date. This MOU may be extended for successive one-year terms upon mutual written agreement of the Parties. • Amendments: o The Parties may request changes to this MOU, which shall be effective only upon the written agreement of the Parties. DocuSign Envelope ID: DACB5D12-B1CF-41A5-8334-DD0B157101D5 o Any changes, modification, revisions, or amendments to this MOU shall be incorporated by written instrument, executed and signed by the Parties, and will be effective in accordance with the terms and conditions contained herein. • Termination: This MOU may be terminated prior to the expiration date upon 30-day written notice and agreement by the Parties to terminate this MOU. Notices Notices. Any notice required or permitted under this MOU shall be in writing and shall be provided by electronic delivery to the e-mail addresses set forth below and by one of the following methods 1) hand- delivery or 2) registered or certified mail, postage pre-paid to the mailing addresses set forth below. Each party by notice sent under this paragraph may change the address to which future notices should be sent. Electronic delivery of notices shall be considered delivered upon receipt of confirmation of delivery on the part of the sender. Nothing contained herein shall be construed to preclude personal service of any notice in the manner prescribed for personal service of a summons or other legal process. To: Rocky Mountain Health Plans Molly Siegel, RAE Clinical Services Director 6251 Greenwood Plaza Blvd., Suite 300 Greenwood Village, CO 80111 To HC Contractor: Eagle County Public Health and Environment Jennie Wahrer, Maternal, Child Health Manager POB 660, 551 Broadway Eagle, CO 81631 jennie.wahrer@eaglecounty.us With copies to: Eagle County Attorney’s Office POB 850 Eagle, CO 81631 atty@eaglecounty.us Signatures All signatories have the appropriate delegation of authority to sign this MOU. //The remainder of this page is intentionally blank// DocuSign Envelope ID: DACB5D12-B1CF-41A5-8334-DD0B157101D5 In Witness whereof, the Parties hereto have caused this MOU to be executed as of the day and year first above written. HC Contractor COUNTY OF EAGLE, STATE OF COLORADO, By and Through Its County Manager By: ______________________________ Jeff Shroll, County Manager RMHP Representative Printed Name: _______________________________________________ Signature: _____________________________________________________________________ Date: _________________________________________________________________________ DocuSign Envelope ID: DACB5D12-B1CF-41A5-8334-DD0B157101D5 12/18/2018 Molly Siegel