Care Management and Care Coordination. 6.1 Integrated Team-Based Care DVHA’s goals are to achieve integrated team-based care that is person-centered for all Members with complex needs who need services from multiple provider types and who would benefit from strong communication and collaboration between those providers, and to support high-functioning Complex Care Ecosystems within each HSA. Members often seek care from a wide spectrum of health and human services providers to support comprehensive treatment of mental health conditions, substance use disorders, other health conditions, social determinant of health needs, and conditions requiring long-term services and supports. Integrated team-based care helps to ensure optimal care management and care coordination for those members. High-functioning Complex Care Ecosystems support integrated team-based care and the Care Model. Contractor shall continue to implement, support, monitor, and evaluate a Care Model that is Member-directed, strengths-based, and responsive to the needs of Attributed Members. Contractor shall participate in activities to further align and improve care integration across the Medicaid benefit, as directed by DVHA. If DVHA conducts assessments of the current state of integrated team-based care and Complex Care Ecosystems, refines approaches to integrated team-based care and Complex Care Ecosystems, or provides forums and trainings to enhance design and implementation of identified approaches, Contractor shall participate in such activities, including attending meetings, reviewing and providing written feedback on approaches and documents, and providing in-kind support (e.g., expertise, faculty) for training and education as requested by DVHA. For attributed members who receive Medicaid-funded case management or care coordination, Contractor shall coordinate the provision of care management and care coordination to ensure services are supplementary and not duplicative. Contractor shall maintain procedures for transitioning Members to or from other care coordination entities or programs, and for graduating members from Contractor’s care coordination program. To the extent that an Attributed Member has needs that can be addressed by ongoing care coordination, but no longer requires intensive care team support, Contractor will ensure that policies and procedures are in place to establish a long-term care coordination relationship and monitor evolving needs of the Member. These procedures shall ensure that care team participan...
Care Management and Care Coordination. 6.1 Integrated Team-Based Care DVHA’s goal is to achieve integrated team-based care for all Attributed Members with complex needs who need services from multiple provider types and who would benefit from strong communication and collaboration between those providers. Members often seek care from a wide spectrum of health and human services providers to support comprehensive treatment of mental health conditions, substance use disorders, other health conditions, social determinant of health needs, and conditions requiring long-term services and supports. Contractor shall develop, implement, support, monitor, and evaluate a Care Model that is Member-directed, strengths-based, and responsive to the needs of Attributed Members. Contractor shall participate in activities to further align and improve care integration across the Medicaid benefit, as directed by DVHA. For attributed members who receive Medicaid-funded case management or care coordination, Contractor shall coordinate the provision of care management and care coordination to ensure services are supplementary and not duplicative. Contractor shall maintain procedures for transitioning Members to or from other care coordination entities or programs, and for graduating members from Contractor’s care coordination program. These procedures shall ensure that care team participants’ work together to facilitate a smooth transition of tasks and responsibilities between care coordination programs and staff. Contractor’s Care Model shall be inclusive of case managers, care coordinators, and other relevant staff from the AHS and community organizations delivering Medicaid funded health care, home- and community-based services, and long-term services and supports. Contractor shall develop and maintain collaborative relationships with State of Vermont agencies, departments, and programs in support of its Care Model activities, including the AHS; Blueprint for Health; Vermont Chronic Care Initiative (VCCI); Department of Disabilities, Aging, and Independent Living; Department of Mental Health (DMH); Vermont Department of Health (VDH); and VDH’s Division of Alcohol and Drug Abuse Programs (ADAP).
Care Management and Care Coordination. 10. In-Reach and Transition from Institutional Settings, c., iii.-vi. is revised and restated as follows:
Care Management and Care Coordination. The Department will not make a Tailored Care Management payment to the PIHP for members who opt out of Tailored Care Management.
Care Management and Care Coordination. 1. Care Needs Screening Report Quarterly report of Member screening results, including Healthy Opportunity & Care Needs Screening of Members. Quarterly
2. High Needs Member Follow-up at Crossover Report Weekly report providing status updates on engagement activities and service disposition of High Need Members (e.g., those in crisis, those who are hospitalized, and those using a high volume of services). Weekly
3. TCM Provider Status Change Report Monthly reporting on tracking TCM provider status changes and the associated decision reasoning. Monthly
Care Management and Care Coordination. $62.50 per contact not provided per Member (i.e., failure to have two of the required contacts for a Member would result in a $125 payment)
Care Management and Care Coordination. $62.50 per occurrence per Member
Care Management and Care Coordination. $500 per occurrence
Care Management and Care Coordination
