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;
Appears in 14 contracts
Samples: Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement
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 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-non- compliance, implement strategies to improve Care Coordination care coordination processes and resolve areas of non-compliance 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;
Appears in 2 contracts
Samples: Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement
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 care coordination processes. The CONTRACTOR shall immediately remediate every finding of poor performance and non-compliance 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-non- compliance, implement strategies to improve Care Coordination care coordination processes and resolve areas of non-compliance 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 Comprehensive needs assessments 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 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;
4.4.13.1.11 Service gaps are identified and addressed in a timely manner; 4.
Appears in 1 contract
