CARE COORDINATOR METRICS AND REPORTING. Pursuant to the PASSE Medicaid Provider Manual, Section II, in order for the PASSE to continue to receive the full Per-Member-Per-Month (PMPM) payment for each PASSE Member, the Care Coordinators employed by the PASSE must meet Quality Performance standards set forth therein. These metrics, targets and required reports are summarized in Appendix H. If the PASSE fails to meet two (2) of the five (5) quality metrics for Care Coordination Quality Performance Metrics, PASSE Quality Performance Metrics or any reporting requirements set forth herein, DHS may take action to correct the failure or impose penalties on the PASSE. On a quarterly basis, in addition to other requirements, the PASSE will submit to DHS a list naming the Care Coordinators and the PASSE Members assigned to them.
CARE COORDINATOR METRICS AND REPORTING. Below is a Summary Table of the Performance Metrics, Targets and Reporting Requirements for Care Coordinators. Prior to taking any compliance action allowed under Section XIV with respect to this Appendix, DHS will informally discuss with the PASSE any metric or target that is not achieved and consider all meaningful efforts that were taken to achieve such target. DHS shall request a corrective action plan if the PASSE does not demonstrate that it took meaningful efforts to substantially comply with this Appendix. Strict compliance, defined as ‘close adherence to specific requirements and enforced rigorously’ is required with the metrics in the following table. Metric Target Reporting to DHS (Frequency/Content) CCs must complete monthly face-to-face contact with all PMs in their caseload: 1. The initial contact must be face-to-face; 2. Ongoing contacts can be accomplished utilizing video conferencing; and 3. If a face-to-face contact is not made, the CC must document at least three (3) attempts to make face-to-face contact at the PM’s place of residence during that month, and the attempts must be at least 24 hours apart 100% of CCs will complete monthly face-to-face contact with all PMs in caseload (strict compliance required) Quarterly/ Details of each completion or attempt to complete every contact with PM in caseload Substantial compliance based upon documented efforts to obtain all needed information is required with the metrics in the following table. Metric Target Reporting to DHS (Frequency/Content) The Care Coordinators (CC) assigned caseload will be limited to a maximum of 50 attributed PASSE Members (PM) 100% of CCs will have a caseload of ≤ 50 PMs (substantial compliance Quarterly/ Details of monthly caseload for each CC employed, including the names of each PM in the CC’s caseload required) CCs must to initiate contact with each PM within 15 business days after attribution to the PASSE ≥75% of CCs will contact each PM within 15 business days after attribution to PASSE (substantial compliance required) Quarterly/ Details of initial contact time frame with each PM after attribution to PASSE, including, but not limited to, date of attribution, date of initial contact and date of completed contact CCs must follow up with PMs within seven (7) business days of visit to Emergency Room or Urgent Care Clinic, or discharge from Hospital or In- Patient Psychiatric Unit/Facility ≥50% of CC will follow up with PMs within seven (7) business days of visit to ...
