Comprehensive Assessments and Individualized Care Plan. Comprehensive Assessment The Contractor must complete Comprehensive Assessments for each new Enrollee on an ongoing basis, including: Within ninety (90) days of each Enrollee’s Effective Enrollment Date into the Contractor’s plan, including subsequent attempts if the initial attempt to contact the Enrollee is unsuccessful, and at least annually thereafter; or Whenever an Enrollee experiences a major change that is: Not temporary or episodic; Impacts on more than one area of health status; and Requires interdisciplinary review or revision of the ICP. The Contractor is not required to newly conduct a Comprehensive Assessment for individuals who were enrolled in the Contractor’s One Care Plan prior to January 1, 2022 and for whom that Comprehensive Assessment is still current. The Contractor must record Comprehensive Assessment results in the Centralized Enrollee Record. The Comprehensive Assessment must include completion of an assessment tool, developed by the Contractor and informed by at least one in‑person meeting covering expanded domains as may be relevant for each Enrollee to creation of his or her ICP. This activity may be conducted at the same time as the MDS‑HC assessment or at a different time, and must be completed within the continuity of care period. As appropriate to the Enrollee’s needs and preferences, the Contractor‑developed assessment tool will include the following domains and special considerations, which may be updated by EOHHS during the Contract period: Immediate needs and current services, including preventive health, preferred providers, what is working well for the Enrollee and what can be improved; Health conditions, including conditions of known prevalence among subpopulations, such as seizures, aspiration, constipation, dehydration, and pica for individuals with intellectual disabilities; Current medications, including how long the Enrollee has been taking each medication, and any need for immunizations or vaccines; The ability of the individual to communicate their concerns or symptoms, including if the individual can verbalize issues and/or whether physical symptoms are manifested through behavior; Functional Status, including ADL and IADL limitations, and what the Enrollee identifies as his/her strengths, weaknesses, interests, and choices about daily routine; Current mental health and substance use, and history of mental health and substance use treatment, including consideration of: Type, duration and frequency of services, including medications; Specialized supports that may be needed, particularly for individuals who utilize the emergency room for a psychiatric or behavioral issue; LTSS; Earlier onset of dementia for individuals with intellectual disabilities; Personal goals, including health goals and activities enjoyed by the Enrollee and barriers to participating; Sexual and reproductive health; At the option of the Enrollee, sexual orientation and gender identity. Accessibility requirements including: Specific communication needs, such as language interpreters/translators, written materials and support to understand treatment options; Needs for transfer equipment; Needs for personal assistance; Appointment scheduling needs; Communication preference; Health literacy; Additional adaptations for appointment and screenings, such as adaptive equipment; and Assistance needed to keep track of appointments and get to them; Equipment needs including adaptive technology; Transportation access, including equipment needed during transportation, and both medical and non‑medical transportation needs; Housing/home environment, including: Needs specific to homeless Enrollees, including those who are Chronically Homeless; Risk of homelessness; Home accessibility requirements; Housing preferences, including who the Enrollee lives with; Methods for heating and cooling Enrollee’s home; Home safety; and Any services provided in a residential setting; Employment status and interest, including school and volunteer work, employment services currently provided to the Enrollee, employment goals and barriers to achieving goals; Involvement or affiliation with other Care Coordinators, care teams, or other State agencies, including current and past involvement, use of self‑directed services through State agencies, and agency contacts; Informal supports/caregiver supports, including availability of back‑up for informal supports, caregiver needs, and Enrollee’s caregiver responsibilities (e.g. children, spouse, parents); Risk factors for abuse and neglect in the Enrollee’s personal life or finances and for experiences of violence; Use of leisure time and community involvement, including preferences, goals and barriers; Social supports, including: Cultural and ethnic orientation or personal beliefs towards the Enrollee’s presenting problems that may influence the Enrollee’s health care; and Involvement with peer support groups; Food security and nutrition, including: Food availability; Access and barriers to healthy food; Oral hygiene; Need for food stamps or meals programs; Nutritional supplements; Wellness and exercise, including types of exercise, self‑rated wellness, and prevention strategies; Advance Directive/guardianship, including health care proxy and power of attorney; and Other domains and/or considerations as may be required by EOHHS. For all Enrollees, the Contractor‑developed assessment tool will also capture information regarding: The Enrollee’s understanding of available services; The Enrollee’s desire to self‑manage all or part of his or her care plan regardless of the severity of disability, and the Enrollee’s understanding of his or her self‑management responsibilities; The Enrollee’s preferences regarding Privacy, services, caregivers, and daily routine; and The Enrollee’s understanding of his or her rights, in accordance with Appendix C. For Enrollees identified by the Contractor, including through the referral, enrollment, or assessment processes as having behavioral health needs, the Contractor‑developed assessment tool will also capture information regarding: The Enrollee’s understanding of, engagement in, and desire to be engaged in recovery‑oriented activities; and The Enrollee’s preferences about the Privacy of his or her behavioral health information, including diagnoses and services received. The Enrollee will be at the center of the assessment and care planning process. The Contractor will ensure that the Enrollee receives information about the Comprehensive Assessment, any necessary assistance and accommodations to prepare for and fully participate in the Comprehensive Assessment, the right to initiate Service Requests, and how to request access to the Comprehensive Assessment. The Contractor will complete the Comprehensive Assessment in a location that meets the needs of the Enrollee, including home‑based assessments as appropriate. With the Enrollee’s consent the Contractor will also gather information from the Enrollee’s providers or other sources of support. Using the information gathered from the Comprehensive Assessment, the Contractor will work with the Enrollee to develop an ICP (see Section 2.6.3 below). As further directed by EOHHS and CMS, the Contractor may, where appropriate, meet this requirement with an existing Comprehensive Assessment for an Enrollee rather than conducting a new Comprehensive Assessment, where such existing Comprehensive Assessment is timely and appropriate, as further defined by EOHHS, in consultation with CMS. The Contractor shall respond to requests by EOHHS or EOHHS’ designee (e.g., EOHHS’ Third Party Administrator (TPA)) for copies of the Comprehensive Assessments of Enrollees seeking LTSS as follows and as further specified by EOHHS: For such an Enrollee for whom a Comprehensive Assessment has been completed, the Contractor shall provide a copy of the Comprehensive Assessment as specified by EOHHS; For such an Enrollee for whom no Comprehensive Assessment has been completed, the Contractor shall provide the information as specified by EOHHS; The Contractor shall designate an individual to receive such requests and shall supply contact information for that individual to EOHHS.
Appears in 3 contracts
Samples: www.mass.gov, www.mass.gov, www.mass.gov
Comprehensive Assessments and Individualized Care Plan. Comprehensive Assessment The Contractor must complete Comprehensive Assessments for each new Enrollee on an ongoing basis, including: Within ninety (90) days of each Enrollee’s Effective Enrollment Date into the Contractor’s plan, including subsequent attempts if the initial attempt to contact the Enrollee is unsuccessful, and at least annually thereafter; or Whenever an Enrollee experiences a major change that is: Not temporary or episodic; Impacts on more than one area of health status; and Requires interdisciplinary review or revision of the ICP. The Contractor is not required to newly conduct a Comprehensive Assessment for individuals who were enrolled in the Contractor’s One Care Plan prior to January 1, 2022 and for whom that Comprehensive Assessment is still current. The Contractor must record Comprehensive Assessment results in the Centralized Enrollee Record. The Comprehensive Assessment must include completion of an assessment tool, developed by the Contractor and informed by at least one in‑person meeting covering expanded domains as may be relevant for each Enrollee to creation of his or her ICP. This activity may be conducted at the same time as the MDS‑HC assessment or at a different time, and must be completed within the continuity of care period. As appropriate to the Enrollee’s needs and preferences, the Contractor‑developed assessment tool will include the following domains and special considerations, which may be updated by EOHHS during the Contract period: Immediate needs and current services, including preventive health, preferred providers, what is working well for the Enrollee and what can be improved; Health conditions, including conditions of known prevalence among subpopulations, such as seizures, aspiration, constipation, dehydration, and pica for individuals with intellectual disabilities; Current medications, including how long the Enrollee has been taking each medication, and any need for immunizations or vaccines; The ability of the individual to communicate their concerns or symptoms, including if the individual can verbalize issues and/or whether physical symptoms are manifested through behavior; Functional Status, including ADL and IADL limitations, and what the Enrollee identifies as his/her strengths, weaknesses, interests, and choices about daily routine; Current mental health and substance use, and history of mental health and substance use treatment, including consideration of: Type, duration and frequency of services, including medications; Specialized supports that may be needed, particularly for individuals who utilize the emergency room for a psychiatric or behavioral issue; LTSS; Earlier onset of dementia for individuals with intellectual disabilities; Personal goals, including health goals and activities enjoyed by the Enrollee and barriers to participating; Sexual and reproductive health; At the option of the Enrollee, sexual orientation and gender identity. Accessibility requirements including: Specific communication needs, such as language interpreters/translators, written materials and support to understand treatment options; Needs for transfer equipment; Needs for personal assistance; Appointment scheduling needs; Communication preference; Health literacy; Additional adaptations for appointment and screenings, such as adaptive equipment; and Assistance needed to keep track of appointments and get to them; Equipment needs including adaptive technology; Transportation access, including equipment needed during transportation, and both medical and non‑medical transportation needs; Housing/home environment, including: Needs specific to homeless Enrollees, including those who are Chronically Homeless; Risk of homelessness; Home accessibility requirements; Housing preferences, including who the Enrollee lives with; Methods for heating and cooling Enrollee’s home; Home safety; and Any services provided in a residential setting; Employment status and interest, including school and volunteer work, employment services currently provided to the Enrollee, employment goals and barriers to achieving goals; Involvement or affiliation with other Care Coordinators, care teams, or other State agencies, including current and past involvement, use of self‑directed services through State agencies, and agency contacts; Informal supports/caregiver supports, including availability of back‑up for informal supports, caregiver needs, and Enrollee’s caregiver responsibilities (e.g. children, spouse, parents); Risk factors for abuse and neglect in the Enrollee’s personal life or finances and for experiences of violence; Use of leisure time and community involvement, including preferences, goals and barriers; Social supports, including: Cultural and ethnic orientation or personal beliefs towards the Enrollee’s presenting problems that may influence the Enrollee’s health care; and Involvement with peer support groups; Food security and nutrition, including: Food availability; Access and barriers to healthy food; Oral hygiene; Need for food stamps or meals programs; Nutritional supplements; Wellness and exercise, including types of exercise, self‑rated wellness, and prevention strategies; Advance Directive/guardianship, including health care proxy and power of attorney; and Other domains and/or considerations as may be required by EOHHS. For all Enrollees, the Contractor‑developed assessment tool will also capture information regarding: The Enrollee’s understanding of available services; The Enrollee’s desire to self‑manage all or part of his or her care plan regardless of the severity of disability, and the Enrollee’s understanding of his or her self‑management responsibilities; The Enrollee’s preferences regarding Privacy, services, caregivers, and daily routine; and The Enrollee’s understanding of his or her rights, in accordance with Appendix C. For Enrollees identified by the Contractor, including through the referral, enrollment, or assessment processes as having behavioral health needs, the Contractor‑developed assessment tool will also capture information regarding: The Enrollee’s understanding of, engagement in, and desire to be engaged in recovery‑oriented activities; and The Enrollee’s preferences about the Privacy of his or her behavioral health information, including diagnoses and services received. The Enrollee will be at the center of the assessment and care planning process. The Contractor will ensure that the Enrollee receives information about the Comprehensive Assessment, any necessary assistance and accommodations to prepare for and fully participate in the Comprehensive Assessment, the right to initiate Service Requests, and how to request access to the Comprehensive Assessment. The Contractor will complete the Comprehensive Assessment in a location that meets the needs of the Enrollee, including home‑based assessments as appropriate. With the Enrollee’s consent the Contractor will also gather information from the Enrollee’s providers or other sources of support. Using the information gathered from the Comprehensive Assessment, the Contractor will work with the Enrollee to develop an ICP (see Section 2.6.3 below). As further directed by EOHHS and CMS, the Contractor may, where appropriate, meet this requirement with an existing Comprehensive Assessment for an Enrollee rather than conducting a new Comprehensive Assessment, where such existing Comprehensive Assessment is timely and appropriate, as further defined by EOHHS, in consultation with CMS. The Contractor shall respond to requests by EOHHS or EOHHS’ designee (e.g., EOHHS’ Third Party Administrator (TPA)) for copies of the Comprehensive Assessments of Enrollees seeking LTSS as follows and as further specified by EOHHS: For such an Enrollee for whom a Comprehensive Assessment has been completed, the Contractor shall provide a copy of the Comprehensive Assessment as specified by EOHHS; For such an Enrollee for whom no Comprehensive Assessment has been completed, the Contractor shall provide the information as specified by EOHHS; The Contractor shall designate an individual to receive such requests and shall supply contact information for that individual to EOHHS.
Appears in 1 contract
Samples: www.mass.gov
