Care Management Plans. The CHC-MCO must make care management plans available to all Participants. Additionally, the CHC-MCO must develop and implement a written care plan for Participants who do not require LTSS but who have unmet needs, service gaps, or a need for Service Coordination. The care management plan must address how the Participant’s physical, cognitive, and BH needs will be care managed, including how Medicare coverage (if the Participant is Dual Eligible) will be coordinated. The CHC-MCO must include in care management plans for Participants who do not require LTSS, at a minimum, the following: • Active chronic problems, current non-chronic problems, cognitive needs, and problems that were previously controlled or classified as maintenance care but have been exacerbated by disease progression or other intervening conditions. • Current medications. • All services authorized and the scope, amount, duration and frequency of the services authorized, including any services that were authorized by the CHC- MCO since the last care management plan was finalized that need to be authorized moving forward. • A schedule of preventive service needs or requirements. • Disease Management action steps. • Known needed physical and behavioral healthcare and services. • All designated points of contact and the Participant’s authorizations of who may request and receive information about the Participant’s services. • How the care manager will assist the Participant in accessing services identified in the care management plan. • How the CHC-MCO will coordinate with the Participant’s Medicare, Veterans Benefits, BH-MCO, Lottery-funded Services and other healthcare insurance providers.
