Common use of Care Plan Implementation Clause in Contracts

Care Plan Implementation. For each Enrollee, a Care Plan is implemented based on the needs assessment, the establishment of goals and objectives, the monitoring of outcomes through regular follow up, and a process to ensure that Care Plans are revised as necessary. These plans must be designed to accommodate the specific cultural and linguistic needs of MSHO Enrollees. For Nursing Facility residents, Care Coordination communication with facility staff and Primary Care as part of an interdisciplinary team must be established to address risk areas and manage services as needed. For Community NHC members and community members, services shall be coordinated with Providers based on the results of the assessment and with input from the Enrollee, family members as appropriate, Primary Care and the Care System team. Primary Care for Enrollees who have not had access to these services in the past must be arranged.