Care Plan Review Sample Clauses

Care Plan Review. (1) Contractors shall contact enrollees at least once a month either by telephone or face-to-face. This contact must be documented in the case notes. The Contractor will ensure the review of the care plan is performed through face-to-face contact with the enrollee at least every third month. The care plan review must address the adequacy and appropriateness of services and determine that the services furnished are consistent with the nature and severity of the enrollee’s needs. (2) The Contractor will review the care plan if the enrollee or anyone involved in providing care or services to the enrollee reports a significant change in the enrollee’s condition. (3) Revisions to the care plan must be done in consultation with the enrollee, the caregiver, and when feasible, the primary care physician. If the primary care physician is not under contract with the Contractor to deliver services to the enrollee, an effort must be made by the case manager to obtain physician’s input regarding care plan revisions. Changes in service provision resulting from a care plan review must be implemented within five (5) business days of the review date unless otherwise specified. (4) If any significant change in condition or services is made to the care plan, the revised care plan shall be distributed in its entirety to the same entities as the initial care plan.