Common use of Children in Xxxxxx Care Clause in Contracts

Children in Xxxxxx Care. No less than quarterly, Contractor’s staff shall meet with DCBS staff to identify, discuss and resolve any health care issues and needs of the Contractor’s Xxxxxx Care membership. Examples of these issues include needed specialized Medicaid Covered Services, community services and whether the child’s current primary and specialty care providers are enrolled in the Contractor’s Network. If the DCBS service plan identifies the need for case management or DCBS staff requests case management for a Member, the Contractor’s staff will work with xxxxxx parent and/or DCBS staff to develop a case management plan. The Contractor’s staff will consult with DCBS staff before the development of a new case management plan (on a newly identified health care issue) or modification of an existing case management plan. The designated Contractor staff will sign each service plan made available by DCBS to indicate their agreement with the plan. If the DCBS and Contractor staff cannot reach agreement on the service plan for a Member, information about that Member’s physical health care needs, unresolved issues in developing the case management plan, and a summary of resolutions discussed by the DCBS and Contractor staff will be forwarded to the designated Department representative. The Contractor shall notify the Department and DCBS no later than three (3) business days prior to the decertification of a xxxxxx child for services at a hospital or other residential facility located in Kentucky and no later than seven (7) business days prior to the decertification of a xxxxxx child for services at a hospital or other residential facility located out of state. Written documentation of an upcoming medical necessity review does not qualify as a decertification notification. The Department shall provide the Contractor with the office or division, the individual(s) and the contact information for such notification and provide updated contact information as necessary. The decertification notification shall include the Member name, Member ID, facility name, level of care, discharge plan and date of next follow-up appointment. If the Contractor fails to notify the Department and DCBS at least three (3) business days or seven (7) business days, as applicable, prior to the decertification and the xxxxxx child remains in the facility because arrangements for placement cannot be made, the Contractor shall be responsible for the time the xxxxxx child remains in the facility prior to notification and up to three (3) business days or seven (7) business days, as applicable, after notification. The Contractor shall require in its contracts with Providers that the Provider provides basic, targeted or intensive case management services as medically necessary to xxxxxx children who are discharged from a hospital or other residential facility. The Contractor, case manager and Provider shall participate in appropriate discharge planning, focused on ensuring that the needed supports and services to meet the Member’s behavioral and physical health needs will be provided outside of the hospital or other residential facility.

Children in Xxxxxx Care. No less than quarterly, Contractor’s staff shall meet with DCBS staff to identify, discuss and resolve any health care issues and needs of the Contractor’s Xxxxxx Care membership. Examples of these issues include needed specialized Medicaid Covered Services, community services and whether the child’s current primary and specialty care providers are enrolled in the Contractor’s Network. If the DCBS service plan identifies the need for case management or DCBS staff requests case management for a Member, the Contractor’s staff will work with xxxxxx parent and/or DCBS staff to develop a case management plan. The Contractor’s staff will consult with DCBS staff before the development of a new case management plan (on a newly identified health care issue) or modification of an existing case management plan. The designated Contractor staff will sign each service plan made available by DCBS to indicate their agreement with the plan. If the DCBS and Contractor staff cannot reach agreement on the service plan for a Member, information about that Member’s physical health care needs, unresolved issues in developing the case management plan, and a summary of resolutions discussed by the DCBS and Contractor staff will be forwarded to the designated Department representative. The Contractor shall notify the Department and DCBS no later than three (3) business days prior to the decertification of a xxxxxx child for services at a hospital or other residential facility located in Kentucky and no later than seven (7) business days prior to the decertification of a xxxxxx child for services at a hospital or other residential facility located out of state. Written documentation of an upcoming medical necessity review does not qualify as a decertification notification. The Department shall provide the Contractor with the office or division, the individual(s) and the contact information for such notification upon the execution of this Amendment and provide updated contact information as necessary. The decertification notification shall include the Member name, Member ID, facility name, level of care, discharge plan and date of next follow-up appointment. If the Contractor fails to notify the Department and DCBS at least three (3) business days or seven (7) business days, days as applicable, applicable prior to the decertification and the xxxxxx child remains in the facility because arrangements for placement cannot be made, the Contractor shall be responsible for the time the xxxxxx child remains in the facility prior to notification and up to three (3) business days or seven (7) business days, days as applicable, after notification. The Contractor shall require in its contracts with Providers that the Provider provides basic, targeted or intensive case management services as medically necessary to xxxxxx children who are discharged from a hospital or other residential facility. The Contractor, case manager and Provider shall participate in appropriate discharge planning, focused on ensuring that the needed supports and services to meet the Member’s behavioral and physical health needs will be provided outside of the hospital or other residential facility.

Children in Xxxxxx Care. Upon Enrollment with the Contractor, each child in Xxxxxx Care shall have a service plan prepared by DCBS. DCBS shall forward a copy of the service plan to the Contractor on each newly enrolled Xxxxxx Care child. No less than quarterlymonthly, Contractor’s DCBS staff shall meet with DCBS Contractor’s staff to identify, discuss and resolve any health care issues and needs of the Contractor’s Xxxxxx Care membershipchild as identified in the service plan. Examples of these issues include needed specialized Medicaid Covered Services, community services and whether the child’s current primary and specialty care providers are enrolled in the Contractor’s Network. If the DCBS service plan identifies the need for case management or DCBS staff requests case management for a Member, the Contractor’s xxxxxx parent and/or DCBS staff will work with xxxxxx parent and/or DCBS Contractor’s staff to develop a case management care plan. The Contractor’s staff Contractor will consult with DCBS staff before the development of a new case management care plan (on a newly identified health care issue) or modification of an existing case management care plan. The DCBS and designated Contractor staff will sign each service plan made available by DCBS to indicate their agreement with the plan. If the DCBS and Contractor staff cannot reach agreement on the service plan for a Member, information about that Member’s physical health care needs, unresolved issues in developing the case management plan, and a summary of resolutions discussed by the DCBS and Contractor staff will be forwarded to the designated county DCBS worker. That DCBS staff member shall work with the designated Contractor representative and a designated Department representative, if needed, to agree on a service plan. If agreement is not reached through mediation, the service plan shall be referred to the Department for resolution through the appeals process. The Contractor shall notify the Department and DCBS no later than three forty-eight (348) business days hours prior to the decertification of a xxxxxx child certified for services at a hospital or other residential facility located in Kentucky and no later than seven (7) business days prior to the decertification of a xxxxxx child for services at a hospital or other residential facility located out of state. Written documentation of an upcoming medical necessity review does not qualify as a decertification notification. The Department and DCBS shall provide the Contractor with the office or division, the individual(s) and the contact information for such notification upon the execution of this Amendment and provide updated contact information as necessary. The decertification notification shall include the Member name, Member ID, facility name, level of care, discharge plan and date of next follow-up appointment. If the Contractor fails to notify the Department and DCBS at least three forty-eight (348) business days hours or seven (7) business days, days as applicable, applicable prior to the decertification and the xxxxxx child remains in the facility because arrangements for placement cannot be made, the Contractor shall be responsible for the time the xxxxxx child remains in the facility prior to notification and up to three (3) business days forty-eight hours or seven (7) business days, days as applicable, after notification. The Contractor shall require in its contracts with Providers that the Provider provides provide basic, targeted or intensive case management services as medically necessary to xxxxxx children who are discharged from a hospital or other residential facility. The Contractor, Contractor shall require the case manager and Provider shall to participate in appropriate discharge planning, focused on ensuring that the needed supports and services to meet the Member’s behavioral and physical health needs will be provided outside of the hospital or other residential facility.