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HomeMy WebLinkAboutC19-387 Rocky Mountain Health Plans Memorandum of Understanding (“MOU”) Rocky Mountain Health Plans (“RMHP”) and Eagle County Government, Healthy Communities Contractor Organization 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 HC contractor and RMHP. The Parties agree to work collaboratively to align and coordinate onboarding and outreach activities. In addition, 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 Members 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 department 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. Examples of trainings will include: o Bridges out of Poverty o Trauma informed Care o Motivational Interviewing DocuSign Envelope ID: B7D2F0F7-4721-48E3-A310-22D88C3D2B3D 11/15/2019 o CareNow – Telehealth 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: • HC contractor can request that RMHP 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 RMHP sends to HFC Members. The HC contractor may use these materials in its outreach activities as it sees fit. HC contractor shall call 888-282- 8801 to request materials. • The Parties will work together to identify HFC Members that either Party believes that such HFC 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. HC contractor will notify the local RMHP care coordination lead if HFC Members are facing barriers accessing primary care, dental care or behavioral health services in their community. • 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 Health Care 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 HC contractor. When outreaching to a HFC Member, the following four (4) domains will be addressed in every initial contact: appropriate emergency department use, primary care, dental and behavioral health. 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 • Community resource referrals • Bilingual staff who can communicate in an HFC Member’s primary language • Supporting Members in understanding their EPSDT benefits (see EPSDT section below for more details) Early and Periodic Screening, Diagnostic and Treatment A) EPSDT Overview DocuSign Envelope ID: B7D2F0F7-4721-48E3-A310-22D88C3D2B3D 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. HC contractor guides families through the process of obtaining both preventive (screening, diagnosis) and sick care/mitigation (treatment). The HC contractor is not a medical provider and does not conduct the screening or provide other medical services directly. B) EPSDT Referral Provisions The HC contractor will provide: • Assistance accessing transportation resources • Contacts to newly eligible HC clients within 60 days of enrollment • Explanation of benefits and referral for providers • Referrals to food resources and other community agencies as needed • Coordination with WIC, Nurse Family Partnership, Head Start, DHS and other agencies • Focus on holistic support for the entire family, not just the child RMHP care coordination and partners will provide: • Care coordination assistance as defined in the care coordination referral section of this MOU. Please see section Referral Criteria. 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 contractor to do any of the following: • Person-centered care planning and collaborative goal setting • Assistance in finding a provider and appointment scheduling (including behavioral health and specialty care) • Identifying gaps related to social determinants of health • 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 Referral Processes A) Referrals from RMHP to HC Contractor: RMHP’s care coordination teams and HC contractor will continue to work together at the local level to establish a process for understanding Eagle County specific resources and services DocuSign Envelope ID: B7D2F0F7-4721-48E3-A310-22D88C3D2B3D provided by the HC contractor and its preferred method of receiving referrals. HC will receive referrals via phone, email or fax. RMHP will refer to the Department of Health Care Policy and Financing website for Healthy Communities team contact information when necessary. Current URL: https://www.colorado.gov/pacific/hcpf/family-health-coordinator-list. B) Referrals from the HC Contractor to RMHP: • Referrals can be made through 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 • RMHP will respond to the referral within 48 hours (two business days). • Follow-up would occur with the local RMHP care coordination team, or Integrated Community Care Team. o The individual care coordinator will follow up with the referral source, as appropriate. o Access to Essette can be granted to view HFC Member details. • When HC makes a referral to RMHP, the referral is documented in a referral campaign in Essette. RMHP will explore access to Essette for HC staff. • Required information to include: o HFC Member Name o HFC Member DOB o Medicaid ID Number o Reason for the referral 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 HFC 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 Data Sharing • The Healthy Communities Program and Contracts Manager at the Department of Health Care Policy and Financing will create and share a bi-annual report with Rocky Mountain Health Plans/RAE Region 1 containing a log of interactions between all mutual member interactions and HC contractor. DocuSign Envelope ID: B7D2F0F7-4721-48E3-A310-22D88C3D2B3D • Twice a year RMHP will provide HC contractor with data about well child care use, prenatal care use, dental care use, emergency department visits, and behavioral health engagement in the population that they serve. • RMHP will explore opportunities to share Key Performance Indicator data with HC representatives. RMHP will explore use of a possible dashboard that includes information on the county level. Meeting Facilitation and Attendance RMHP will facilitate region-wide meetings on a quarterly basis and be responsive to ad hoc meeting requests by the Healthy Communities contractors. At least one representative from each Healthy Communities contractor (e.g. Family Health Coordinator, Supervisor) 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. 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 Molly.siegel@rmhp.org DocuSign Envelope ID: B7D2F0F7-4721-48E3-A310-22D88C3D2B3D 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. 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: B7D2F0F7-4721-48E3-A310-22D88C3D2B3D 11/15/2019 Molly Siegel