Care Coordination Monitoring. 4.4.13.1 The CONTRACTOR shall develop a comprehensive program for monitoring, on an ongoing basis, the effectiveness of its Care Coordination processes. The CONTRACTOR shall immediately remediate every finding of poor performance and non-compliance identified through its monitoring process, and shall also track and trend such findings and remediations to identify systemic issues of poor performance and/or non-compliance, implement strategies to improve Care Coordination processes and resolve areas of non-compliance and shall measure the success of such strategies in addressing identified issues. At a minimum, the CONTRACTOR shall ensure that:
4.4.13.1.1 Care coordination tools and protocols are consistently and objectively applied and outcomes are continuously measured to determine effectiveness and appropriateness of processes;
4.4.13.1.2 Level of care assessments and reassessments occur on schedule and are submitted to lead or supervising care coordinator;
4.4.13.1.3 CNAs and reassessment, as applicable, occur on schedule and in compliance with this Agreement;
4.4.13.1.4 CCPs are developed and updated on schedule and in compliance with this Agreement;
4.4.13.1.5 CCPs reflect needs identified in the Comprehensive Needs Assessment and reassessment process;
4.4.13.1.6 CCPs are appropriate and adequate to address the Member’s needs;
4.4.13.1.7 Services are delivered as described in the CCP and authorized by the CONTRACTOR;
4.4.13.1.8 Services are appropriate to address the Member’s needs;
4.4.13.1.9 Services are delivered in a timely manner; 4.4.13.1.10 Service utilization is appropriate;
Care Coordination Monitoring. 2.9.6.12.1 The CONTRACTOR shall develop a comprehensive program for monitoring, on an ongoing basis, the effectiveness of its care coordination processes. The CONTRACTOR shall immediately remediate all individual findings identified through its monitoring process, and shall also track and trend such findings and remediations to identify systemic issues of poor performance and/or non-compliance, implement strategies to improve care coordination processes and resolve areas of non-compliance, and shall measure the success of such strategies in addressing identified issues. At a minimum, the CONTRACTOR shall ensure that:
2.9.6.12.1.1 Care coordination tools and protocols are consistently and objectively applied and outcomes are continuously measured to determine effectiveness and appropriateness of processes;
2.9.6.12.1.2 Level of care assessments and reassessments occur on schedule and are submitted to TENNCARE in accordance with requirements in Section 2.9.6.9.3.1.1;
2.9.6.12.1.3 Needs assessments and reassessment, as applicable, occur on schedule and in compliance with this Agreement;
2.9.6.12.1.4 Plans of care for CHOICES Groups 2 and 3 are developed and updated on schedule and in compliance with this Agreement;
2.9.6.12.1.5 Plans of care for CHOICES Groups 2 and 3 reflect needs identified in the needs assessment and reassessment process;
2.9.6.12.1.6 Plans of care for CHOICES Groups 2 and 3 are appropriate and adequate to address member needs;
2.9.6.12.1.7 Services are delivered as described in the plan of care and authorized by the CONTRACTOR;
2.9.6.12.1.8 Services are appropriate to address the member’s needs;
2.9.6.12.1.9 Services are delivered in a timely manner;
2.9.6.12.1.10 Service utilization is appropriate;
2.9.6.12.1.11 Service gaps are identified and addressed in a timely manner;
2.9.6.12.1.12 Minimum care coordinator contacts are conducted;
2.9.6.12.1.13 Care coordinator-to-member ratios are appropriate;
2.9.6.12.1.14 The cost neutrality cap for members in CHOICES Group 2 and the expenditure cap for members in CHOICES Group 3 are monitored and appropriate action is taken if a member is nearing or exceeds his/her cost neutrality or expenditure cap; and
2.9.6.12.1.15 That benefit limits are monitored and that appropriate action is taken if a member is nearing or exceeds a benefit limit.
2.9.6.12.2 The CONTRACTOR shall provide to TENNCARE the reports required by Section 2.30.
2.9.6.12.3 The CONTRACTOR shall purchase and implement an electronic vi...
