Common use of Cost-effective Plan Test Clause in Contracts

Cost-effective Plan Test. Using the Department-approved service authorization policy, test whether a cost- effective plan can be developed for supporting the member’s outcomes and assuring the member’s health and safety during the absence by considering: a. Is there a reason, related to the member’s long term care outcomes, for the member to be out of the MCO service area? b. Is there a way for the MCO to effectively arrange and manage the member’s services during the absence? Factors to consider include: i. Duration of absence; ii. Distance from MCO; iii. Availability of providers; and iv. Ability to monitor the care plan directly, through contracting or other arrangements. c. Is there an effective way to arrange and manage the member’s services during the absence that is cost-effective? Factors to consider include: i. Cost in comparison to effectiveness in supporting the member’s long term care outcomes; ii. Cost in comparison to the member’s care plan costs when in the service area; iii. MCO staff time and effort in comparison to time and effort when in the service area; and iv. Duration of absence.

Cost-effective Plan Test. Using the Department-approved service authorization policy, test whether a cost- effective plan can be developed for supporting the member’s outcomes and assuring the member’s health and safety during the absence by considering: a. Is there a reason, related to the member’s long term care outcomes, for the member to be out of the MCO service area? b. Is there a way for the MCO to effectively arrange and manage the member’s services during the absence? Factors to consider include: i. Duration of absence; ii. Distance from MCO; iii. Availability of providers; and, iv. Ability to monitor the care plan directly, through contracting or other arrangements. c. Is there an effective way to arrange and manage the member’s services during the absence that is cost-effective? Factors to consider include: i. Cost in comparison to effectiveness in supporting the member’s long term care outcomes; ii. Cost in comparison to the member’s care plan costs when in the service area; iii. MCO staff time and effort in comparison to time and effort when in the service area; and, iv. Duration of absence.

Cost-effective Plan Test. Using the Department-approved service authorization policy, test whether a cost- effective plan can be developed for supporting the member’s outcomes and assuring the member’s health and safety during the absence by considering: a. Is there a reason, related to the member’s long long-term care outcomes, for the member to be out of the MCO PO service area? b. Is there a way for the MCO PO to effectively arrange and manage the member’s services during the absence? Factors to consider include: i. Duration of absence; ii. Distance from MCOPO; iii. Availability of providers; and iv. Ability to monitor the care plan directly, through contracting or other arrangements. c. Is there an effective way to arrange and manage the member’s services during the absence that is cost-effective? Factors to consider include: i. Cost in comparison to effectiveness in supporting the member’s long long-term care outcomes; ii. Cost in comparison to the member’s care plan costs when in the service area; iii. MCO PO staff time and effort in comparison to time and effort when in the service area; and iv. Duration of absence.

Cost-effective Plan Test. Using the Department-approved service authorization policy, test whether a cost- effective plan can be developed for supporting the member’s outcomes and assuring the member’s health and safety during the absence by considering: a. Is there a reason, related to the member’s long term care outcomes, for the member to be out of the MCO service area? b. Is there a way for the MCO to effectively arrange and manage the member’s services during the absence? Factors to consider include: i. Duration of absence; ii. Distance from MCO; iii. Availability of providers; and, iv. Ability to monitor the care plan directly, through contracting or other arrangements. c. Is there an effective way to arrange and manage the member’s services during the absence that is cost-effective? Factors to consider include: i. Cost in comparison to effectiveness in supporting the member’s long term care outcomes; ii. Cost in comparison to the member’s care plan costs when in the service area; iii. MCO staff time and effort in comparison to time and effort when in the service area; and, iv. Duration of absence.

Cost-effective Plan Test. Using the Department-approved service authorization policy, test whether a cost- effective plan can be developed for supporting the member’s outcomes and assuring the member’s health and safety during the absence by considering: a. Is there a reason, related to the member’s long term care outcomes, for the member to be out of the MCO PO service area? b. Is there a way for the MCO PO to effectively arrange and manage the member’s services during the absence? Factors to consider include: i. Duration of absence; ii. Distance from MCOPO; iii. Availability of providers; and iv. Ability to monitor the care plan directly, through contracting or other arrangements. c. Is there an effective way to arrange and manage the member’s services during the absence that is cost-effective? Factors to consider include: i. Cost in comparison to effectiveness in supporting the member’s long term care outcomes; ii. Cost in comparison to the member’s care plan costs when in the service area; iii. MCO PO staff time and effort in comparison to time and effort when in the service area; and iv. Duration of absence.