Академический Документы
Профессиональный Документы
Культура Документы
DRAFT
SUMMARY
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1 (b) Each member has a consistent and stable relationship with a care
2 team that is responsible for comprehensive care management and service
3 delivery.
4 (c) The supportive and therapeutic needs of each member are addressed
5 in a holistic fashion, using patient centered primary care homes, behavioral
6 health homes or other models that support patient centered primary care and
7 behavioral health care and individualized care plans to the extent feasible.
8 (d) Members receive comprehensive transitional care, including appropri-
9 ate follow-up, when entering and leaving an acute care facility or a long
10 term care setting.
11 (e) Members receive assistance in navigating the health care delivery
12 system and in accessing community and social support services and statewide
13 resources, including through the use of certified health care interpreters and
14 qualified health care interpreters, as those terms are defined in ORS 413.550.
15 (f) Services and supports are geographically located as close to where
16 members reside as possible and are, if available, offered in nontraditional
17 settings that are accessible to families, diverse communities and underserved
18 populations.
19 (g) Each coordinated care organization uses health information technol-
20 ogy to link services and care providers across the continuum of care to the
21 greatest extent practicable and if financially viable.
22 (h) Each coordinated care organization complies with the safeguards for
23 members described in ORS 414.635.
24 (i) Each coordinated care organization convenes a community advisory
25 council that meets the criteria specified in ORS 414.627.
26 (j) Each coordinated care organization prioritizes working with members
27 who have high health care needs, multiple chronic conditions, mental illness
28 or chemical dependency and involves those members in accessing and man-
29 aging appropriate preventive, health, remedial and supportive care and ser-
30 vices, including the services described in ORS 414.766, to reduce the use of
31 avoidable emergency room visits and hospital admissions.
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1 demonstration project under section 1115 of the Social Security Act (42
2 U.S.C. 1315).
3 (c) [Operating] Operate within a fixed global budget and spending on
4 primary care, as defined by the authority by rule, at least 12 percent of the
5 coordinated care organization’s total expenditures for physical and mental
6 health care provided to members, except for expenditures on prescription
7 drugs, vision care and dental care.
8 (d) [Developing and implementing] Develop and implement alternative
9 payment methodologies that are based on health care quality and improved
10 health outcomes.
11 (e) [Coordinating] Coordinate the delivery of physical health care, mental
12 health and chemical dependency services, oral health care and covered
13 long-term care services.
14 (f) [Engaging] Engage community members and health care providers in
15 improving the health of the community and addressing regional, cultural,
16 socioeconomic and racial disparities in health care that exist among the co-
17 ordinated care organization’s members and in the coordinated care
18 organization’s community.
19 (2) In addition to the criteria and requirements specified in subsection
20 (1) of this section, the authority must adopt by rule requirements for coor-
21 dinated care organizations contracting with the authority so that:
22 (a) Each member of the coordinated care organization receives integrated
23 person centered care and services designed to provide choice, independence
24 and dignity.
25 (b) Each member has a consistent and stable relationship with a care
26 team that is responsible for comprehensive care management and service
27 delivery.
28 (c) The supportive and therapeutic needs of each member are addressed
29 in a holistic fashion, using patient centered primary care homes, behavioral
30 health homes or other models that support patient centered primary care and
31 behavioral health care and individualized care plans to the extent feasible.
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