Care Management Standards. A. The Contractor will maintain regular contact with Vermont Chronic Care Initiative (VCCI) to ensure that efforts around care management are well coordinated through regular and ad-hoc in-person and telephonic meetings; at minimum, the Contractor agrees to a meeting monthly but as frequently as both parties agree is needed.
B. The Contractor will maintain as needed contact with other Vermont Agency of Human Services (AHS) departments engaged in care management or care coordination activities particularly as it relates to federal mandates (e.g., Early Periodic Screening, Diagnosis, and Treatment) and vulnerable populations (e.g., Disabilities, Traumatic Brain Injury, Integrated Family Services). Examples of this contact will include but not be limited to: meetings (in- person and telephonic), educational outreach, partnering, launching or rolling out new or existing initiatives, and direct care coordination.
C. If requested, the Contractor will, no more frequently than annually and no sooner than 60 days from the request, participate with the State to create a written plan describing detailed approach to care management activities described above. Any AHS employee and/or contractor who provides care coordination services to Medicaid eligible persons shall, to the best of his/her ability, and so long as it is consistent with AHS programs or procedures and with Medicaid’s legal obligations, cooperate with the Clinical Model or Care Model developed by the ACO. Should there be a conflict between the ACO’s Clinical Model or Care Model and AHS programs or procedures, AHS employees and contractors shall cooperate with and implement the Clinical Model or Care Model of the ACO for a mutually agreeable time frame. DVHA and AHS acknowledge that this cooperation is critical to ACO in order to meet the quality, patient experience and financial performance thresholds under this Agreement. In the event of a dispute regarding the Clinical Model or Care Model, the parties may invoke the Dispute Resolution process set forth in Section 5 of Attachment A.
Care Management Standards. The contractor shall develop and implement care management as defined in Article 1 with adequate capacity to provide services to all enrollees who would benefit from care management services. In addition, the
Care Management Standards. The contractor shall develop and implement care management as defined in Article 1, consistent with standards for Dual-Eligible Special Needs Plans as required by Section 1859(f) of the Social Security Act (42 U.S.C. 1395w–28(f)), 42 CFR 422.152(g)(2)(ix) (evidence-based model of care) and 42 CFR 422.101(f) (Special Needs Plan Model of Care) with adequate capacity to provide services to all enrollees who would benefit from care management services.
Care Management Standards. A. The Contractor will maintain regular contact with Vermont Chronic Care Initiative (VCCI) to ensure that efforts around care management are well coordinated through regular and ad-hoc in-person and telephonic meetings; at minimum, the Contractor agrees to a meeting monthly but as frequently as both parties agree is needed.
B. The Contractor will maintain as needed contact with other Vermont Agency of Human Services (AHS) departments engaged in care management or care coordination activities particularly as it relates to federal mandates (e.g., Early Periodic Screening, Diagnosis, and Treatment) and vulnerable populations (e.g., Disabilities, Traumatic Brain Injury, Integrated Family Services). Examples of this contact will include but not be limited to: meetings (in- person and telephonic), educational outreach, partnering, launching or rolling out new or existing initiatives, and direct care coordination.
C. The Contractor’s Care Management programs will be consistent with and be guided by the eleven (11) principles outlined in the Care Management Standards approved by the SIM Care Models/Care Management work group, set forth below in paragraphs 1-2.
Care Management Standards a. Care Management Oversight (based partially on NCQA ACO Standards PO1, Element B, and PC2, Element A)
