Assessing for Pilot Eligibility and Recommending Pilot Services Sample Clauses

Assessing for Pilot Eligibility and Recommending Pilot Services. 1. The PHP shall ensure that the Member’s care management team, by using NCCARE360: i. Uses the Department-standardized PESA to assess and document a Member’s Pilot program eligibility (based on the Pilot program eligibility criteria outlined in this Section), Pilot service-level eligibility outlined in the Healthy Opportunities Pilot Fee Schedule, and recommended Pilot services based on the Healthy Opportunities Pilot Fee Schedule. ii. Documents, where appropriate, Member preferences for, and relationships with, particular HSOs. iii. Completes the PESA for a Member’s initial Pilot eligibility assessment and service recommendations and updates the Member’s PESA any time there is a change to the Member’s Pilot service needs or eligibility. iv. Uses the PESA as the assessment and documentation tool for the Member’s three (3) month Pilot service mix review and six (6) month Pilot eligibility reassessment as required in Section V.C.8.g.xxix.
Sample 1
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Related to Assessing for Pilot Eligibility and Recommending Pilot Services

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