Care Coordination and Continuity of Care

County of Santa Clara Health System

Care Coordination and Continuity of Care

Policy & Procedure (BHSD #10000)

​ Reference:

  • 42 CFR § 438.208 Coordination and continuity of care
  • 42 CFR § 438.62(b)(1)-(2) Continued services to beneficiaries
  • 42 CFR § 438.3(I) Choice of Provider
  • 42 CFR § 438.114(d)(3) Emergency and Post stabilization Services
  • 42 CFR Part 2 Confidentiality of Substance Use Disorder Patient Records
  • 45 C.F.R. § 160 and §164 Health Insurance Portability and Accountability Act
  • CCR § 1810.370. Memorandum of Understanding (MOU) with Medi-Cal Managed Care Plans
  • 9 CCR §1810.425. Hospital Selection Criteria
  • BHSD Practice Guidelines Manual (MH only) August 1, 2017
Definitions:

Assessment. A service activity designed to evaluate the current status of mental, emotional, or behavioral health. Assessment includes, but is not limited to, one or more of the following: mental status determination, analysis of the clinical history, analysis of relevant cultural issues and history; diagnosis; and the use of mental health testing procedures. 

Beneficiary. A Medi-Cal recipient who is currently receiving services from BHSD or a BHSD contracted provider.

Provider.  A person or entity who is licensed, certified, or otherwise recognized or authorized under state law governing the healing arts to provide specialty mental health services and who meets the standards for participation in the Medi-Cal program as described in California Code of Regulations, Title 9, Division 1, Chapters 10 or 11 and in Division 3, Subdivision 1 of Title 22, beginning with Section 50000. The provider includes but is not limited to licensed mental health professionals, clinics, hospital outpatient departments, certified day treatment facilities, certified residential treatment facilities, skilled nursing facilities, psychiatric health facilities, general acute care hospitals, and acute psychiatric hospitals. The MHP is a provider when direct services are provided to beneficiaries by employees of the Mental Health Plan.

Policy:

  The Behavioral Health Services Department (BHSD) will ensure:

  1. Each beneficiary has an ongoing source of care appropriate to his or her needs.
  2. A person or entity is formally designated as primarily responsible for coordinating services accessed by the beneficiary.
  3. The beneficiary is provided information on how to contact their designated person or entity.
  4. Each beneficiary’s right to change the designated network provider when such change is clinically appropriate and possible.

 Care Coordination Services will occur:

  1. Between settings of care, including appropriate discharge planning for short and long-term hospital stays, substance use withdrawal management, residential placements, institutional stays, and all levels of outpatient care.
  2. With services, a beneficiary receives from any other Managed Care Plan (MCP).
  3. With services, a beneficiary receives from Fee for Service (FFS).
  4. With services, a beneficiary received from the community and social support providers.

Care coordination efforts will ensure that the beneficiary’s privacy is protected according to all state and federal regulations.

Procedure​

Attachments:

SCVHHS Authorization for Use or Disclosure of Protected Health Information (BHSD ROI)

Obtaining and Complying with Patient Authorization

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