Care Coordination for Special and High Needs Populations. The CONTRACTOR’s Care Coordination program description shall reflect Care Coordination requirements specific to special and high needs populations described in this Section 4.4.9. For JUST Health TOC Members, the CONTRACTOR shall complete the Justice Involved TOC Assessment/Plan/HRA template that is in Section 5.12 of the Managed Care Policy Manual. For Members receiving services from CSAs, CCBHCs, CYFD, ECECD, DOH, Corrections, School Systems, FQHCs, Housing Entities, BHSD, and/or other Member-serving entities, the CONTRACTOR shall ensure that the Member-serving agency or entity is included in Care Coordination processes described in Section 4.4 of this Agreement. For Members receiving HCBS in a provider owned or controlled setting, the care coordinator shall assess Member experience and provider compliance with federal home- and community-based (HCB) settings requirements during face-to-face visits with Members, using the process and tools approved by HCA. The care coordinator’s assessment is intended to determine ongoing provider compliance with federal HCB settings requirements. The CONTRACTOR shall employ or contract with dedicated care coordinators and supervisors with relevant expertise to meet the needs for each population listed below. The dedicated number of care coordinators for each population must be commensurate with the proportion of the CONTRACTOR’s enrollment size for each of these populations. Justice-Involved Individuals; Traumatic Brain Injury Members; Medically Fragile Members; Individuals with Intellectual Disabilities; Children and Adults with Special Health Care Needs; Members with Housing Insecurity needs; Members with complex Behavioral Health needs, including SUD; CISC; and CARA Members. Comprehensive Addiction Recovery Act (CARA) program The Comprehensive Addiction Recovery Act (CARA) is a 2016 federal law-that amended the Child Abuse and Treatment Act (CAPTA), was adopted in New Mexico in 2019 under legislation (HB230), and is administered by CYFD, HCA, and ECECD. CARA is a program that offers supports and services to the families of babies who are born with exposure to substances that can affect their health and development. These substances include, but are not limited to alcohol, nicotine, marijuana, and drugs or medications, including controlled or prescribed substances such as opioids. XXXX requires that all infants born exposed to substances have a comprehensive plan of care created by the hospital discharge team and that...
Care Coordination for Special and High Needs Populations. 4.4.9.1 The CONTRACTOR’s Care Coordination program description shall reflect Care Coordination requirements specific to special and high needs populations described in this Section 4.4.9.
