Assignment of Care Coordinator. The CONTRACTOR shall assign a specific care coordinator to each Member assigned to CCL1 or CCL2. The CONTRACTOR shall notify the Member of the assigned care coordinator and how to contact the care coordinator as set forth in the Managed Care Policy Manual. When assigning care coordinators to Members, the CONTRACTOR shall consider the alignment of the care coordinator’s qualifications, expertise, geographic proximity, language, and cultural background with the needs or preferences of the Member. The CONTRACTOR’s considerations shall include, but are not limited to, the following: The assigned care coordinator for Members who choose the SDBC shall have specific experience with self-direction and additional training regarding self-direction. The CONTRACTOR must make reasonable accommodations for non-English speaking Members who request assignment to a care coordinator who speaks the Member’s preferred language. If a Native American Member requests assignment to a Native American care coordinator the CONTRACTOR must employ or contract with a Native American care coordinator or contract with a CHR to serve as the care coordinator. The CONTRACTOR shall make reasonable efforts to offer a Native American care coordinator from the same Tribe, Nation, or Pueblo as the Member. The CONTRACTOR shall allow the Member to change their assigned Care Coordinator. However, in order to ensure continuity of care, the CONTRACTOR shall minimize the number of changes in a Member’s care coordinator initiated by the CONTRACTOR. Caseload Ratios The CONTRACTOR shall establish and maintain maximum caseloads ratios per care coordinator for Members in CCL0, CCL1, and CCL2. The CONTRACTOR’s maximum caseload ratios shall not exceed the following: CCL0 - 1:150 CCL1 - 1:75 CCL2 - 1:50 As the CONTRACTOR delegates more Care Coordination functions to local resources, the CONTRACTOR may request, in writing, an adjustment to Care Coordination caseload requirements from HCA. All caseload ratio adjustments must be prior approved by HCA in writing. Comprehensive Care Plan The CONTRACTOR's Care Coordination program description shall specify the CONTRACTOR’s process for developing, sharing, and updating the Comprehensive Care Plan (CCP). The process shall be consistent with the CCP requirements in this Section 4.4.6. The CONTRACTOR shall develop and implement CCPs, using HCA’s standardized CCP, for Members in CCL1 and CCL2 within fourteen (14) Business Days of completion of the initial CNA, unless th...
Assignment of Care Coordinator. 4.4.5.5.1 The CONTRACTOR shall assign a specific care coordinator to each Member assigned to CCL2 or CCL3.
