Care Coordination Staffing and Training. 4.4.3.1 Care Coordination Staffing
Care Coordination Staffing and Training. Care Coordination Staffing The CONTRACTOR may use a Care Coordination team approach to performing Care Coordination activities described in Section 4.4 of this Agreement. For Members in Care Coordination Levels (CCLs) one (1) and two (2), the CONTRACTOR’s Care Coordination team shall consist of the Member’s care coordinator and other Care Coordination staff with relevant expertise and experience necessary to address the needs of the Members. The CONTRACTOR shall use local resources, such as I/T/Us, primary care and specialty clinics, Patient Centered Medical Homes (PCMHs), Health Homes, Core Service Agencies (CSAs), School-Based Health Center (SBHCs), CHWs, Community Health Representatives (CHRs), High Fidelity Wrap-Around (HFW) Teams, Paramedicine programs, community-based agencies, PCS agencies, Centers for Independent Living, and Tribal services, reimbursing them in mutually agreeable arrangements, to assist in performing the Care Coordination functions specified throughout Section 4.4 of this Agreement. The CONTRACTOR shall perform monitoring and oversight of all Care Coordination functions delegated to local resources, per Section 7.14.2.1.3 of this Agreement. The CONTRACTOR's Care Coordination program description shall specify: The qualifications, experience, and training of each member of the Care Coordination team and how the CONTRACTOR ensures that Care Coordination key functions are performed by a qualified care coordinator and supervised by a qualified supervisor. At a minimum, unless otherwise approved by HCA, the CONTRACTOR shall ensure that the care coordinator completing the CNA has a bachelor's degree or two (2) years of relevant health care experience; and a care coordinator's direct supervisor has a bachelor's degree and a minimum of two (2) years of relevant health care experience, unless approved in writing by HCA; The number of care coordinators, Care Coordination supervisors, and other Care Coordination team members dedicated to the CONTRACTOR’s Care Coordination program; The proposed ratio of care coordinators, subject to HCA-established maximum caseload ratios, to Members and the analysis that supports the proposed ratios are sufficient to meet the needs of the CONTRACTOR’s Members. The CONTRACTOR’s proposed ratios shall consider travel requirements for care coordinators serving Members in Rural, Frontier, and Tribal areas of the State and Members who require more extensive Care Coordination support; The method by which the CONTRACT...
