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Care transition protocols
Procedures defined in the MOC to keep care continuous when an enrollee moves between care settings, such as after a hospital discharge.
Standard 1.10 checks whether the organization developed and implemented care transition protocols to maintain continuity of care as defined in the MOC. Evidence can include case management or ICT notes, correspondence with PCPs, specialists, hospitals or facilities, and discharge planning discussions. Table 1IA Column R asks whether transitional care was offered to a hospitalized enrollee after discharge.
Source: SNPCC protocol, Compliance standard 1.10 (PDF p. 7); Table 1IA Column ID R (PDF p. 17).