Care Plan and Service Delivery Requirements Sample Clauses

Care Plan and Service Delivery Requirements. (1) The Contractor is required to develop an individualized plan of care for every new enrollee referred by the CARES offices. Services included in the care plan will be determined by the Contractor in consultation with the enrollee or their representative using the initial assessment provided by CARES as well as the Contractor’s assessment. (2) The care plan shall be in a format approved by the Department. (3) A care plan utilizing case management only will be subject to review by the Department and the enrollment may be reviewed for appropriateness. (4) The care plan must be based on a comprehensive assessment of the enrollee’s health status, physical and cognitive functioning, environment, social supports, and end-of-life decisions. The care plan must clearly identify barriers and explore potential solutions with the enrollee and caregivers. The care plan must detail all interventions designed to address specific barriers to independent functioning. The care plan must include any services provided through the enrollee’s own informal network or by volunteers from community social service agencies or other organizations such as churches and synagogues. (5) The care plan must include at a minimum the following components as specified in 42 CFR 441.351(f) and as required by the Department: a. The enrollee’s name; b. The enrollee’s date of birth or Medicaid Number; c. Care plan effective date; d. Care plan review date; e. Covered services provided including routine medical and HCBS services f. Begin date and end date; g. Providers; h. Amount and frequency; July 2012 Contract XT220 i. Case manager's signature; and j. Enrollee or the enrollee's authorizaed representative's signature and date is required on the care plan or care plan summary, whichever document is given to the enrollee. (6) In developing the care plan, the Contractor must perform the following: a. Assess the immediacy of the new enrollee’s service needs and include a description of the enrollee’s condition, as identified through an appropriate comprehensive assessment and a medical history review. b. Identify any existing care plans and service providers and assess the adequacy of current services. c. Provide for continuous care to the new enrollee if the enrollee is receiving active treatment prior to the effective date of enrollment. d. Ensure that the care plan contains information about the enrollee’s medical condition, the type of services to be furnished, the amount, frequency and duratio...