Common use of CHOICES or ECF CHOICES HCBS Providers Clause in Contracts

CHOICES or ECF CHOICES HCBS Providers. If Provider is a CHOICES or ECF CHOICES HCBS provider, in addition to the other requirements set forth in the Agreement or this Appendix, Provider shall: (a) Provide at least thirty (30) days advance notice to Subcontractor and Health Plan when Provider is no longer willing or able to provide services to a Covered Person, including the reason for the decision. Provider shall cooperate with the Covered Person’s Care or Support Coordinator to facilitate a seamless transition to alternate providers; (b) In the event that a CHOICES or ECF CHOICES HCBS provider change is initiated for a Covered Person, regardless of any other provision of the Agreement, Provider shall continue to provide services to the Covered Person in accordance with the Covered Person’s person-centered support plan (“PCSP”), as appropriate, until the Covered Person has been transitioned to a new provider, as determined by Subcontractor, or as otherwise directed by Health Plan, which may exceed thirty (30) days from the date of notice to Subcontractor, unless the Covered Person refuses continuation of services, the Covered Person’s health and welfare would be otherwise at risk by remaining with Provider, or if continuing to provide services is reasonably expected to place staff that would deliver services at imminent risk of harm. Prior to discontinuing services to the Covered Person, or prior to Provider’s termination of the Agreement, as applicable, Provider shall: i) Provide a written notification of the planned service discontinuation to the Covered Person, his/her conservator or guardian, and his/her support coordinator, no less than thirty (30) days prior to the proposed date of services discontinuation or termination of the Agreement; ii) Obtain Subcontractor or Health Plan’s written approval, in the form of a signed PCSP, to discontinue the services and cooperation with the transition to any subsequent, authorized service provider as is necessary; and iii) Consult and cooperate with United in the preparation of a discharge plan for all Covered Persons receiving care and service from Provider in the event of a proposed termination of service. When appropriate, as part of the discharge plan, Provider shall meet, consult and cooperate with any new providers to ensure continuity of care and as smooth a transition as possible. (c) Provider’s reimbursement shall be contingent upon the provision of Covered Services to an eligible Covered Person in accordance with applicable federal and state requirements and the Covered Person’s plan of care as authorized by Subcontractor and Health Plan, and must be supported by detailed documentation of service delivery to support the amount of services billed, including at a minimum, the date, time and location of service, the specific HCBS provided, the name of the Covered Person receiving the service, the name of the staff person who delivered the service, the detailed tasks and functions performed as a component of each service, notes for other caregivers (whether paid or unpaid) regarding the member or his/her needs (as applicable), and the initials or signature of the staff person who delivered the service; (d) Provider shall immediately report any deviations from a Covered Person’s service schedule to the Covered Person’s Care or Support Coordinator; (e) Provider shall use the electronic visit verification system specified by Subcontractor in accordance with Health Plan’s requirements; (f) Upon acceptance by Provider to provide approved services to a Covered Person as indicated in the Covered Person’s PCSP, as appropriate, Provider shall ensure that it has staff sufficient to provide the service(s) authorized by Subcontractor or Health Plan in accordance with the Covered Person’s PSCP, as appropriate, including the amount, frequency, duration and scope of each service in accordance with the Covered Person’s service schedule; (g) Provider shall provide back-up for its own staff if a staff member is unable to fulfill an assignment for any reason. Provider shall ensure that back-up staff meet the qualifications for the authorized Covered Service; (h) Provider is prohibited from requiring a Covered Person to choose Provider as a provider of multiple services as a condition of providing any service to the Covered Person; (i) Provider is prohibited from soliciting Covered Persons to receive services from Provider, including: (1) Referring an individual for CHOICES or ECF CHOICES screening and intake with the expectation that, should CHOICES enrollment occur, Provider will be selected by the Covered Person as the service provider; or (2) Communicating with existing CHOICES or ECF CHOICES members via telephone, face-to-face or written communication for the purpose of petitioning the Covered Person to change CHOICES or ECF CHOICES providers; (3) Communicating with hospitals, discharge planners or other institutions for the purposes of soliciting potential CHOICES or ECF CHOICES members that should instead be referred to the person’s MCO, AAAD or DIDD, as applicable; (j) Provider shall comply with critical incident reporting and management requirements as prescribed by TennCare, including those specified in section A.2.15.7 of the CRA; (k) Provider is not required to have liability insurance in excess of TennCare requirements in effect prior to the implementation of CHOICES or ECF CHOICES; (l) Provider may not alter any official CHOICES or ECF CHOICES brochures or other materials unless United has submitted a request to do so to TennCare and obtained prior written approval from TennCare in accordance with section A.2.17 of the CRA; (m) Provider may not reproduce CHOICES or ECF CHOICES logos for its own use unless United has submitted a request to do so to TennCare and obtained prior written approval from TennCare; and (n) Provider is required to submit copies of current licensure and/or certification (as applicable) to Subcontractor and/or Health Plan. (o) Provider will maintain compliance with the HCBS Settings Rule detailed in 42 C.F.R. § 441.301(c)(4)-(5). (p) If Provider is utilizing the Electronic Visit Verification (EVV) System, Provider shall ensure that all HCBS workers complete and submit worker surveys upon logging out of each visit using a format and in a manner prior approved by TennCare. (q) In the event there is a proposed change of ownership of Provider, the new provider shall provide to the Division of TennCare documents sufficient to obtain a Medicaid ID based on appropriate documentation submitted by the new provider and any managed care contractor previously contracted with the former owner or operator. United and the new provider shall negotiate a new provider agreement in good faith. A new provider with a Medicaid ID and an executed contract with United, which shall include, but not be limited to, the assumption of the previous owner’s contract, a new contract with United, or a single case agreement, shall be reimbursed at one hundred percent (100%) from the effective date of the change of ownership. A new provider with a Medicaid ID, but without an executed contract with United, shall be reimbursed eighty percent (80%) from the effective date of the change of ownership, with a retroactive payment to the effective date of the change of ownership of an additional twenty percent (20%) due after the execution of a contract with United. A new provider with a change of ownership that has not acquired a Medicaid ID shall not be reimbursed, including retroactively, until such provider acquires a Medicaid ID. (r) If DIDD is providing quality monitoring for Provider, as specified by TENNCARE, Provider must cooperate with all quality monitoring processes and requirements as described within this Appendix, the State Contract and/or TENNCARE quality monitoring protocols. If Provider is a CHOICES or ECF CHOICES HCBS provider who renders PERS, assistive technology, minor home modifications, or pest control services, Provider shall meet all the requirements of the State Contract, the Agreement and this Appendix, applicable to Provider’s services under the Agreement.

CHOICES or ECF CHOICES HCBS Providers. If Provider is a CHOICES or ECF CHOICES HCBS provider, in addition to the other requirements set forth in the Agreement or this Appendix, Provider shall: (a) Provide at least thirty (30) days advance notice to Subcontractor and Health Plan when Provider is no longer willing or able to provide services to a Covered Person, including the reason for the decision. Provider shall cooperate with the Covered Person’s Care or Support Coordinator to facilitate a seamless transition to alternate providers; (b) In the event that a CHOICES or ECF CHOICES HCBS provider change is initiated for a Covered Person, regardless of any other provision of the Agreement, Provider shall continue to provide services to the Covered Person in accordance with the Covered Person’s person-centered support plan (“PCSP”), as appropriate, of care until the Covered Person has been transitioned to a new provider, as determined by Subcontractor, or as otherwise directed by Health Plan, which may exceed thirty (30) days from the date of notice to Subcontractor, unless the Covered Person refuses continuation of services, the Covered Person’s health and welfare would be otherwise at risk by remaining with Providerthe current provider, or if continuing to provide services is reasonably expected to place staff that would deliver services at imminent risk of harm. Prior to discontinuing services to the Covered Person, or prior to Provider’s termination of the Agreement, as applicable, Provider shall: i) Provide a written notification of the planned service discontinuation to the Covered Person, his/her conservator or guardian, and his/her support coordinator, no less than thirty (30) days prior to the proposed date of services discontinuation or termination of the Agreement; ii) Obtain Subcontractor or Health Plan’s written approval, in the form of a signed PCSP, to discontinue the services and cooperation with the transition to any subsequent, authorized service provider as is necessary; and iii) Consult and cooperate with United in the preparation of a discharge plan for all Covered Persons receiving care and service from Provider in the event of a proposed termination of service. When appropriate, as part of the discharge plan, Provider shall meet, consult and cooperate with any new providers to ensure continuity of care and as smooth a transition as possible. (c) Provider’s reimbursement shall be contingent upon the provision of Covered Services to an eligible Covered Person in accordance with applicable federal and state requirements and the Covered Person’s plan of care as authorized by Subcontractor and Health Plan, and must be supported by detailed documentation of service delivery to support the amount of services billed, including at a minimum, the date, time and location of service, the specific HCBS provided, the name of the Covered Person receiving the service, the name of the staff person who delivered the service, the detailed tasks and functions performed as a component of each service, notes for other caregivers (whether paid or unpaid) regarding the member or his/her needs (as applicable), and the initials or signature of the staff person who delivered the service; (d) Provider shall immediately report any deviations from a Covered Person’s service schedule to the Covered Person’s Care or Support Coordinator; (e) Provider shall use the electronic visit verification system specified by Subcontractor in accordance with Health Plan’s requirements; (f) Upon acceptance by Provider to provide approved services to a Covered Person as indicated in the Covered Person’s PCSP, as appropriateplan of care, Provider shall ensure that it has staff sufficient to provide the service(s) authorized by Subcontractor or Health Plan in accordance with the Covered Person’s PSCP, as appropriateplan of care, including the amount, frequency, duration and scope of each service in accordance with the Covered Person’s service schedule; (g) Provider shall provide back-up for its own staff if a staff member is unable to fulfill an assignment for any reason. Provider shall ensure that back-up staff meet the qualifications for the authorized Covered Service; (h) Provider is prohibited from requiring a Covered Person to choose Provider as a provider of multiple services as a condition of providing any service to the Covered Person; (i) Provider is prohibited from soliciting Covered Persons to receive services from Provider, including: (1) Referring an individual for CHOICES or ECF CHOICES screening and intake with the expectation that, should CHOICES enrollment occur, Provider will be selected by the Covered Person as the service provider; or (2) Communicating with existing CHOICES or ECF CHOICES members via telephone, face-to-face or written communication for the purpose of petitioning the Covered Person to change CHOICES or ECF CHOICES providers; (3) Communicating with hospitals, discharge planners or other institutions for the purposes of soliciting potential CHOICES or ECF CHOICES members that should instead be referred to the person’s MCO, AAAD or DIDD, as applicable; (j) Provider shall comply with critical incident reporting and management requirements as prescribed by TennCare, including those specified in section A.2.15.7 of the CRA; (k) Provider is not required to have liability insurance in excess of TennCare requirements in effect prior to the implementation of CHOICES or ECF CHOICES; (l) Provider may not alter any official CHOICES or ECF CHOICES or MFP brochures or other materials unless United prior approval has submitted a request to do so to TennCare and been obtained prior written approval from TennCare in accordance with section A.2.17 of the CRA; (m) Provider may not reproduce CHOICES or ECF CHOICES or MFP logos for its own use unless United prior approval has submitted a request to do so to TennCare and been obtained prior written approval from TennCare; and (n) Provider is required to submit copies of current licensure and/or certification (as applicable) to Subcontractor and/or Health Plan. (o) Provider will maintain compliance with the HCBS Settings Rule detailed in 42 C.F.R. § 441.301(c)(4)-(5). (p) If Provider is utilizing the Electronic Visit Verification (EVV) System, Provider shall ensure that all HCBS workers complete and submit worker surveys upon logging out of each visit using a format and in a manner prior approved by TennCare. (q) In the event there is a proposed Provider undergoes a change of ownership of Providerownership, the new provider owner shall provide to the Division of TennCare documents sufficient with a bill of sale (or equivalent) and documentation from the appropriate State licensing entity that the new owner is allowed to obtain operate under the existing license until such time as a new license is issued. The Division of TennCare shall issue a new Medicaid ID based on appropriate the documentation submitted by the new provider owner and any managed care contractor previously contracted with Subcontractor or Health Plan, as applicable, shall issue a new agreement to the former owner or operator. United Provider and load the rates based on the next weekly rate file following the Division of TennCare’s receipt of the new provider shall negotiate a new provider agreement in good faithProvider’s documentation. A new provider with a Medicaid ID and an executed contract with UnitedSubcontractor or Health Plan, which shall include, but not be limited to, the assumption of the previous owner’s contract, a new contract with United, or a single case agreementas applicable, shall be reimbursed at one hundred percent (100%) from reimburse the effective date of the change of ownership. A new provider with a Medicaid ID, but without an executed contract with United, shall be reimbursed eighty percent (80%) from the effective date of the change of ownership, with a retroactive payment to the effective date of the change of ownership of an additional twenty percent (20%) due after the execution of a contract with United. A new provider with a change of ownership that has not acquired a Medicaid ID shall not be reimbursed, including retroactively, until such provider acquires a Medicaid ID. (r) If DIDD is providing quality monitoring for Provider, as specified based on rates provided by TENNCAREthe Division of TennCare, Provider must cooperate with all quality monitoring processes within 30 days and requirements as described retrospectively adjust affected claims within this Appendix, the State Contract and/or TENNCARE quality monitoring protocols60 days. If Provider is a CHOICES or ECF CHOICES HCBS provider who renders PERS, assistive technology, minor home modifications, or pest control services, Provider shall meet all the requirements of the State Contract, the Agreement and this Appendix, applicable to Provider’s services under the Agreement.

CHOICES or ECF CHOICES HCBS Providers. If Provider is a CHOICES or ECF CHOICES HCBS provider, in addition to the other requirements set forth in the Agreement or this Appendix, Provider shall: (a) Provide at least thirty (30) days advance notice to Subcontractor and Health Plan when Provider is no longer willing or able to provide services to a Covered Person, including the reason for the decision. Provider shall cooperate with the Covered Person’s Care or Support Coordinator to facilitate a seamless transition to alternate providers; (b) In the event that a CHOICES or ECF CHOICES HCBS provider change is initiated for a Covered Person, regardless of any other provision of the Agreement, Provider shall continue to provide services to the Covered Person in accordance with the Covered Person’s person-centered support plan (“PCSP”), as appropriate, of care until the Covered Person has been transitioned to a new provider, as determined by Subcontractor, or as otherwise directed by Health Plan, which may exceed thirty (30) days from the date of notice to Subcontractor, unless the Covered Person refuses continuation of services, the Covered Person’s health and welfare would be otherwise at risk by remaining with Providerthe current provider, or if continuing to provide services is reasonably expected to place staff that would deliver services at imminent risk of harm. Prior to discontinuing services to the Covered Person, or prior to Provider’s termination of the Agreement, as applicable, Provider shall: i) Provide a written notification of the planned service discontinuation to the Covered Person, his/her conservator or guardian, and his/her support coordinator, no less than thirty (30) days prior to the proposed date of services discontinuation or termination of the Agreement; ii) Obtain Subcontractor or Health Plan’s written approval, in the form of a signed PCSP, to discontinue the services and cooperation with the transition to any subsequent, authorized service provider as is necessary; and iii) Consult and cooperate with United in the preparation of a discharge plan for all Covered Persons receiving care and service from Provider in the event of a proposed termination of service. When appropriate, as part of the discharge plan, Provider shall meet, consult and cooperate with any new providers to ensure continuity of care and as smooth a transition as possible. (c) Provider’s reimbursement shall be contingent upon the provision of Covered Services to an eligible Covered Person in accordance with applicable federal and state requirements and the Covered Person’s plan of care as authorized by Subcontractor and Health Plan, and must be supported by detailed documentation of service delivery to support the amount of services billed, including at a minimum, the date, time and location of service, the specific HCBS provided, the name of the Covered Person receiving the service, the name of the staff person who delivered the service, the detailed tasks and functions performed as a component of each service, notes for other caregivers (whether paid or unpaid) regarding the member or his/her needs (as applicable), and the initials or signature of the staff person who delivered the service; (d) Provider shall immediately report any deviations from a Covered Person’s service schedule to the Covered Person’s Care or Support Coordinator; (e) Provider shall use the electronic visit verification system specified by Subcontractor in accordance with Health Plan’s requirements; (f) Upon acceptance by Provider to provide approved services to a Covered Person as indicated in the Covered Person’s PCSP, as appropriateplan of care, Provider shall ensure that it has staff sufficient to provide the service(s) authorized by Subcontractor or Health Plan in accordance with the Covered Person’s PSCP, as appropriateplan of care, including the amount, frequency, duration and scope of each service in accordance with the Covered Person’s service schedule; (g) Provider shall provide back-up for its own staff if a staff member is unable to fulfill an assignment for any reason. Provider shall ensure that back-up staff meet the qualifications for the authorized Covered Service; (h) Provider is prohibited from requiring a Covered Person to choose Provider as a provider of multiple services as a condition of providing any service to the Covered Person; (i) Provider is prohibited from soliciting Covered Persons to receive services from Provider, including: (1) Referring an individual for CHOICES or ECF CHOICES screening and intake with the expectation that, should CHOICES enrollment occur, Provider will be selected by the Covered Person as the service provider; or (2) Communicating with existing CHOICES or ECF CHOICES members via telephone, face-to-face or written communication for the purpose of petitioning the Covered Person to change CHOICES or ECF CHOICES providers; (3) Communicating with hospitals, discharge planners or other institutions for the purposes of soliciting potential CHOICES or ECF CHOICES members that should instead be referred to the person’s MCO, AAAD or DIDD, as applicable; (j) Provider shall comply with critical incident reporting and management requirements as prescribed by TennCare, including those specified in section A.2.15.7 of the CRA; (k) Provider is not required to have liability insurance in excess of TennCare requirements in effect prior to the implementation of CHOICES or ECF CHOICES; (l) Provider may not alter any official CHOICES or ECF CHOICES or MFP brochures or other materials unless United prior approval has submitted a request to do so to TennCare and been obtained prior written approval from TennCare in accordance with section A.2.17 of the CRA; (m) Provider may not reproduce CHOICES or ECF CHOICES or MFP logos for its own use unless United prior approval has submitted a request to do so to TennCare and been obtained prior written approval from TennCare; and (n) Provider is required to submit copies of current licensure and/or certification (as applicable) to Subcontractor and/or Health Plan. (o) Provider will maintain compliance with the HCBS Settings Rule detailed in 42 C.F.R. § 441.301(c)(4)-(5). (p) If Provider is utilizing the Electronic Visit Verification (EVV) System, Provider shall ensure that all HCBS workers complete and submit worker surveys upon logging out of each visit using a format and in a manner prior approved by TennCare. (q) In the event there is a proposed change of ownership of Provider, the new provider shall provide to the Division of TennCare documents sufficient to obtain a Medicaid ID based on appropriate documentation submitted by the new provider and any managed care contractor previously contracted with the former owner or operator. United and the new provider shall negotiate a new provider agreement in good faith. A new provider with a Medicaid ID and an executed contract with United, which shall include, but not be limited to, the assumption of the previous owner’s contract, a new contract with United, or a single case agreement, shall be reimbursed at one hundred percent (100%) from the effective date of the change of ownership. A new provider with a Medicaid ID, but without an executed contract with United, shall be reimbursed eighty percent (80%) from the effective date of the change of ownership, with a retroactive payment to the effective date of the change of ownership of an additional twenty percent (20%) due after the execution of a contract with United. A new provider with a change of ownership that has not acquired a Medicaid ID shall not be reimbursed, including retroactively, until such provider acquires a Medicaid ID. (r) If DIDD is providing quality monitoring for Provider, as specified by TENNCARE, Provider must cooperate with all quality monitoring processes and requirements as described within this Appendix, the State Contract and/or TENNCARE quality monitoring protocols. If Provider is a CHOICES or ECF CHOICES HCBS provider who renders PERS, assistive technology, minor home modifications, or pest control services, Provider shall meet all the requirements of the State Contract, the Agreement and this Appendix, applicable to Provider’s services under the Agreement.