For ALL CHOICES Members Sample Clauses

For ALL CHOICES Members. 2.9.6.9.3.1 The CONTRACTOR shall provide for the following ongoing care coordination to all CHOICES members: 2.9.6.9.3.1.1 Conduct a level of care reassessment at least annually and within five (5) business days of the CONTRACTOR’s becoming aware that the member’s functional or medical status has changed in a way that may affect level of care eligibility. 2.9.6.9.3.1.1.1 If the level of care assessment indicates a change in the level of care or if the assessment was prompted by a request by a member, a member’s representative or caregiver or another entity for a change in level of services, the assessment shall be forwarded to TENNCARE for determination; 2.9.6.9.3.1.1.2 If the level of care assessment indicates no change in level of care, the CONTRACTOR shall document the date the level of care assessment completed in the member’s file; any level of care assessments prompted by a request for a change in level of services shall be submitted to TENNCARE for determination. 2.9.6.9.3.1.2 Facilitate access to physical and/or behavioral health services as needed, including transportation to services as specified in Section 2.6.1 and Attachment XI; except as provided in Sections 2.11.1.8 or 2.6.5, transportation for HCBS is not included; 2.9.6.9.3.1.3 Monitor and ensure the provision of covered physical health, behavioral health, and/or long-term care services as well as services provided as a cost-effective alternative to other covered services and ensure that services provided meet the member’s needs; 2.9.6.9.3.1.4 Provide assistance in resolving concerns about service delivery or providers; 2.9.6.9.3.1.5 Coordinate with a member’s PCP, specialists and other providers, such as the member’s mental health case manager, to facilitate a comprehensive, holistic, person-centered approach to care; 2.9.6.9.3.1.6 Contact providers and workers on a periodic basis and coordinate with providers and workers to collaboratively address issues regarding member service delivery and to maximize community placement strategies; 2.9.6.9.3.1.7 Share relevant information with and among providers and others when information is available and it is necessary to share for the well-being of the member; 2.9.6.9.3.1.8 Determine the appropriate course as specified herein upon (1) receipt of any contact made by or on behalf of a member, regardless of source, which asserts that the member’s needs are not met by currently authorized services; (2) the member’s hospitalization; or (3) other circu...