Functions and Duties of the Contractor. The Contractor shall: A. Provide or arrange for the delivery of all Authorized Services to each Participant for the term of the Participant's enrollment. B. Conduct assessments using the instruments and at the frequency specified by the Department, including the assessments identified in Appendix A. C. Maintain a record for each Participant and require its Network Providers to maintain a record for each Participant. 1. The record maintained by each Network Provider must document all care provided and comply with the requirements specified in the Department's Medical Assistance regulations that are appropriate to the standard of care for that Provider. 2. The Contractor's record for each Participant must include, at a minimum, the following: a. Identification of the Participant on each page b. Identifying demographic information c. A complete medical history d. The Participant's complaints accompanied by the Contractor's findings e. A preliminary working diagnosis as well as a final diagnosis based on the Participant's history and examination f. Documentation of all services provided, including documentation of the medical necessity of a rendered, ordered, or prescribed service g. Multi-disciplinary assessments, reassessments, plans of care, treatment and progress notes h. Drugs prescribed as part of the treatment, including the quantities and dosage, and if the prescription was telephoned to a pharmacist i. Lab reports, including interpretations of diagnostic tests and reports of consultations j. Hospital discharge records k. Reports from the Contractor and Providers l. Contacts with informal supports (Participant's family, friends, church, etc.) m. The Participant's signed Enrollment Agreement, which includes a statement that the Participant or, if appropriate, the Participant's representative, received the Participant Handbook and the Participant Handbook was reviewed with the Participant or, if appropriate, the Participant’s representative n. Physician orders o. The Participant’s ISP, including if developed for the Participant, the Behavioral Support Plan, the Crisis Intervention Plan and the Restrictive Procedure Plan, and the Contingency Plan for each service in the ISP, and all updates and revisions to the ISP and Contingency Plan p. The Participant’s Skill Building Plan, if developed for the Participant, and all updates and revisions to the Skill Building Plan q. The Participant’s Medication Therapeutic Management Plan, if developed for the Participant, and all updates and revisions to the Medication Therapeutic Management Plan r. The Participant’s Restrictive Procedure Plan, the signatures of the members of the Human Rights Team that approved the Restrictive Procedure Plan, and a record of each use of a Restrictive Procedure that includes the following (when applicable for non-physical Restrictive Procedures, i.e., medication box, money safe): i. Documentation of the specific behavior addressed through the use of the Restrictive Procedure; ii. The method or procedure of Restrictive Procedure used; iii. The date and time the Restrictive Procedure was used; iv. The staff person who used the Restrictive Procedure; v. The duration of the Restrictive Procedure; and vi. The Participant’s condition during and following the removal of the Restrictive Procedure.
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Samples: Adult Community Autism Program Agreement, Adult Community Autism Program Agreement, Adult Community Autism Program Agreement
Functions and Duties of the Contractor. The Contractor shall:
A. Provide or arrange for the delivery of all Authorized Services to each Participant for the term of the Participant's enrollment.
B. Conduct assessments using the instruments and at the frequency specified by the Department, including the assessments identified in Appendix A.
C. Maintain a record for each Participant and require its Network Providers to maintain a record for each Participant.
1. The record maintained by each Network Provider must document all care provided and comply with the requirements specified in the Department's Medical Assistance regulations that are appropriate to the standard of care for that Provider.
2. The Contractor's record for each Participant must include, at a minimum, the following:
a. Identification of the Participant on each page
b. Identifying demographic information
c. A complete medical history
d. The Participant's complaints accompanied by the Contractor's findings
e. A preliminary working diagnosis as well as a final diagnosis based on the Participant's history and examination
f. Documentation of all services provided, including documentation of the medical necessity of a rendered, ordered, or prescribed service
g. Multi-disciplinary assessments, reassessments, plans of care, treatment and progress notes
h. Drugs prescribed as part of the treatment, including the quantities and dosage, and if the prescription was telephoned to a pharmacist i. Lab reports, including interpretations of diagnostic tests and reports of consultations
j. Hospital discharge records
k. Reports from the Contractor and Providers
l. Contacts with informal supports (Participant's family, friends, church, etc.)
m. The Participant's signed Enrollment Agreement, which includes a statement that the Participant or, if appropriate, the Participant's representative, received the Participant Handbook and the Participant Handbook was reviewed with the Participant or, if appropriate, the Participant’s representative
n. Physician orders
o. The Participant’s ISP, including if developed for the Participant, the Behavioral Support Plan, the Crisis Intervention Plan and the Restrictive Procedure Intervention Plan, and the Contingency Plan for each service in the ISP, and all updates and revisions to the ISP and Contingency Plan
p. The Participant’s Skill Building Plan, if developed for the Participant, and all updates and revisions to the Skill Building Plan q. The Participant’s Medication Therapeutic Management Plan, if developed for the Participant, and all updates and revisions to the Medication Therapeutic Management Plan
r. The Participant’s Restrictive Procedure Plan, the signatures of the members of the Human Rights Team that approved the Restrictive Procedure Plan, and a record of each use of a Restrictive Procedure that includes the following (when applicable for non-physical Restrictive Procedures, i.e., medication box, money safe):
i. Documentation of the specific behavior addressed through the use of the Restrictive Procedure;
ii. The method or procedure of Restrictive Procedure used;
iii. The date and time the Restrictive Procedure was used;
iv. The staff person who used the Restrictive Procedure;
v. The duration of the Restrictive Procedure; and
vi. The Participant’s condition during and following the removal of the Restrictive Procedure.
Appears in 1 contract
Functions and Duties of the Contractor. The Contractor shall:
A. Provide or arrange for the delivery of all Authorized Services to each Participant for the term of the Participant's enrollment.
B. Conduct assessments using the instruments and at the frequency specified by the Department, including the assessments identified in Appendix A.
C. Maintain a record for each Participant and require its Network Providers to maintain a record for each Participant.
1. The record maintained by each Network Provider must document all care provided and comply with the requirements specified in the Department's Medical Assistance regulations that are appropriate to the standard of care for that Provider.
2. The Contractor's record for each Participant must include, at a minimum, the following:
a. Identification of the Participant on each page
b. Identifying demographic information
c. A complete medical history
d. The Participant's complaints accompanied by the Contractor's findings
e. A preliminary working diagnosis as well as a final diagnosis based on the Participant's history and examination
f. Documentation of all services provided, including documentation of the medical necessity of a rendered, ordered, or prescribed service
g. Multi-disciplinary assessments, reassessments, plans of care, treatment and progress notes
h. Drugs prescribed as part of the treatment, including the quantities and dosage, and if the prescription was telephoned to a pharmacist i. Lab reports, including interpretations of diagnostic tests and reports of consultations
j. Hospital discharge records
k. Reports from the Contractor and Providers
l. Contacts with informal supports (Participant's family, friends, church, etc.)
m. The Participant's signed Enrollment Agreement, which includes a Agreement and signed statement that verifying the Participant Participant's or, if appropriate, the Participant's representative' s, received review and receipt of the Participant Handbook and the Participant Handbook was reviewed with the Participant or, if appropriate, the Participant’s representativeHandbook
n. Physician orders
o. The Participant’s initial ISP and FBA based ISP, including if developed for the ParticipantCrisis Intervention Plan, the Behavioral Support Plan, the Crisis Intervention Plan and the Restrictive Procedure Planmedication therapeutic management plan, and the Contingency Plan for each service in the ISP, and all updates and revisions to the ISP and Contingency Planrevisions.
p. The Participant’s Skill Building Plandisposition of the case
3. The record shall be legible throughout and entries shall be signed and dated by the responsible Provider. Care rendered by ancillary personnel shall be countersigned by the responsible Provider. Alterations of the record shall be signed and dated.
D. Maintain an after-hours call-in system to provide prompt and easy access, if developed for twenty-four (24) hours per day, seven (7) days per week, three-hundred sixty-five (365) days per year, to Covered Services when medically necessary.
E. Ensure that a physician and Behavioral Health Specialist are on call to provide prompt, professional consultation to Participants twenty-four (24) hours per day, seven (7) days per week, three- hundred sixty-five (365) days per year.
F. Provide prompt access to Habilitation and Supports Coordination services using Contractor's staff and to all other services using either Contractor's staff or Providers.
G. Develop and maintain a Network sufficient to provide prompt access to Covered Services that are not required to be delivered directly by the Participant, and all updates and revisions Contractor. During the first six (6) months after BAS begins to accept inquiries about enrollment in the Skill Building Plan q. The Participant’s Medication Therapeutic Management Plan, if developed for the Participant, and all updates and revisions to the Medication Therapeutic Management Plan
r. The Participant’s Restrictive Procedure Plan, the signatures Contractor must offer Participants a choice of at least two (2) Network Providers in the following disciplines: Primary care (including family practitioners and general internists), psychiatry, neurology, gynecology, urology, gastroenterology, endocrinology, dentistry, and optometry; and one
(1) Network Provider for all other disciplines. Thereafter the Contractor must offer Participants a choice of at least two (2) Network Providers for each service or Provider type. The Contractor shall enter into written agreements with all Providers as specified in Section 2 .5.
H. Demonstrate to the Department, and provide supporting documentation, that it has the capacity to serve the expected enrollment in the Service Area in accordance with the requirements in this Agreement by:
1. Maintaining an updated list of all Provider subcontracts that includes Provider name, address, phone number, services provided under the subcontract, subcontract expiration date, and whether or not the subcontract is automatically renewable.
2. Submitting a list of all subcontracts with Providers to the Department at the time the Contractor enters into this Agreement and upon request.
3. Submitting an updated list of Network Provider subcontracts within two days of the Contractor's knowledge of a change that would affect capacity and services.
I. Require Network Providers to offer hours of operation that are no less than the hours of operation offered to commercial patients or comparable to the hours offered for individuals who receive Medical Assistance services in the fee-for-service delivery system, if the Network Provider serves only Medical Assistance patients.
J. Ensure that every Participant has an assigned Primary Care Provider (PCP). Unless it would be to the Participant's benefit, the PCP must participate in the Contractor's Network. The assigned PCP may be a specialist, if the needs of a Participant warrant. The Contractor must offer each Participant a choice of at least two (2) PCPs. If a Participant fails to choose a PCP within fourteen (14) days of enrollment in the Plan, the Contractor must assign a PCP to the Participant. In assigning PCPs, the Contractor must consider current Provider-Participant relationships, special medical needs, area of residence, language and other needs, and access to transportation. The Contractor must have written procedures and policies for allowing the Participant to change his or her PCP. These procedures must receive advance written approval from the BAS.
K. Respond, report, and follow up on all incidents as specified in Appendix X.
X. Assign a Team to each Participant, which is responsible for assessment, service planning, care delivery and managing delivery of services, quality of services, and continuity of care.
1. The Team shall include at a minimum:
a. The Participant and the Participant's guardian, if the Participant has a guardian, and his or her family consistent with the Participant's or guardian's wishes.
b. A Behavioral Health Specialist
c. A Supports Coordinator Other disciplines that must be available to the Team either in person or by phone or become members of the Human Rights Team as needed include a physician, nurse, physical and occupational therapists, dietitian, and ancillary staff engaged in Participant diagnosis and treatment or who are responsible for the initiation, provision, coordination, or evaluation of care and services provided to the Participant. BAS must also be allowed to participate in Team meetings if BAS has notified the Contractor that approved it wants to participate in the Restrictive Procedure Team meetings. Team members shall not change except as necessary to meet the needs of the Participant.
2. The Team is responsible for developing an Initial ISP within fourteen (14) days of being notified by BAS that an Applicant is eligible for enrollment in the Plan. The timeframe for developing the Initial ISP may be extended for circumstances beyond the Contractor's control with prior approval from BAS.
3. The Team is responsible for developing an FBA-Based ISP that is consistent with and supports the functional behavioral assessment, and which includes a Behavioral Support Plan, a Crisis Intervention Plan, and a record medication therapeutic management plan within sixty (60) days of enrollment. The time frame for completing the FBA-Based ISP may be extended for circumstances beyond the Contractor's control with prior approval from BAS. The FBA- Based ISP must be reviewed at least every three (3) months and after each episode that triggers implementation of the Crisis Intervention Plan or the use of a Restrictive Procedure that includes Restraint and must be reassessed and updated at least annually. Monitoring and annual reassessments must address the following (when applicable for nonParticipant's progress toward more inclusive and less restrictive services than were provided the previous year.
4. The Team must use a Person-physical Restrictive ProceduresCentered Planning process in developing the Initial ISP and in developing, i.e.reviewing, medication box, money safe):and updating or revising the FBA-Based ISP. The Person- Centered Planning process must include:
i. Documentation of a. Understanding the specific behavior addressed through Participant's needs and desires in the use of the Restrictive Procedurepresent and future;
ii. The method b. Identifying the services and other supports the Participant will need to meet his or procedure of Restrictive Procedure used;
iii. The date her needs and time the Restrictive Procedure was used;
iv. The staff person who used the Restrictive Procedure;
v. The duration of the Restrictive Proceduredesires; and
vic. Determining what steps need to be taken to meet the Participant's needs and desires.
5. The Initial ISP and the FBA-Based ISP must include the Covered Services agreed to by the Team, and any other services and informal supports that complement the Covered Services that will be furnished to or coordinated for the Participant’s condition during ; which services the Contractor will pay for, the projected amount, frequency, and following duration of services; the removal justification for each service; and the goals, objectives, and expected outcomes of the Restrictive Procedureplan. In order to be authorized, Covered Services must be Medically Necessary; meet the Participant's needs in the most inclusive, cost-effective, and least-restrictive manner appropriate for the Participant's needs; and build on the Participant's strengths to improve social skills and self- management in ways that increase independence and participation in community life. Documentation must be included in the Initial ISP and the FBA-Based ISP that describes the decision-making process and how the services meet this requirement.
Appears in 1 contract
Functions and Duties of the Contractor. The Contractor shall:
A. Provide or arrange for the delivery of all Authorized Services to each Participant for the term of the Participant's enrollment.to
B. Conduct assessments using the instruments and at the frequency specified by the Department, including the assessments identified in Appendix A.
C. Maintain a record for each Participant and require its Network Providers to maintain a record for each Participant.
1. The record maintained by each Network Provider must document all care provided and comply with the requirements specified in the Department's Medical Assistance regulations that are appropriate to the standard of care for that Provider.
2. The Contractor's record for each Participant must include, at a minimum, the following:
a. Identification of the Participant on each page
b. Identifying demographic information
c. A complete medical history
d. The Participant's complaints accompanied by the Contractor's findings
e. A preliminary working diagnosis as well as a final diagnosis based on the Participant's history and examination
f. Documentation of all services provided, including documentation of the medical necessity of a rendered, ordered, or prescribed service
g. Multi-disciplinary assessments, reassessments, plans of care, treatment and progress notes
h. Drugs prescribed as part of the treatment, including the quantities and dosage, and if the prescription was telephoned to a pharmacist i. Lab reports, including interpretations of diagnostic tests and reports of consultations
j. Hospital discharge records
k. Reports from the Contractor and Providers
l. Contacts with informal supports (Participant's family, friends, church, etc.)
m. The Participant's signed Enrollment Agreement, which includes a Agreement and signed statement that verifying the Participant Participant's or, if appropriate, the Participant's representative's, received review and receipt of the Participant Handbook and the Participant Handbook was reviewed with the Participant or, if appropriate, the Participant’s representativeHandbook
n. Physician orders
o. The Participant’s ISP, including if developed for the Participant, the Behavioral Support Plan, Plan and the Crisis Intervention Plan and the Restrictive Procedure Plan, and the Contingency Plan for each service in the ISP, and all updates and revisions to the ISP and Contingency Plan
p. The Participant’s Skill Building Plan, if developed for the Participant, and all updates and revisions to the Skill Building Plan q. The Participant’s Medication Therapeutic Management Plan, if developed for the Participant, and all updates and revisions to the Medication Therapeutic Management Plan
r. The Participant’s Restrictive Procedure Plan, the signatures of the members of the Human Rights Team that approved the Restrictive Procedure Plan, Intervention Plan and a record of each use of a Restrictive Procedure Intervention that includes the following (when applicable for non-physical Restrictive ProceduresInterventions, i.e., medication box, money safe):
i. Documentation of the specific behavior addressed through the use of the Restrictive ProcedureIntervention;
ii. The method or procedure of Restrictive Procedure usedIntervention used and the behavior addressed by the Restrictive Intervention;
iii. The date and time the Restrictive Procedure Intervention was used;
iv. The staff person who used the Restrictive ProcedureIntervention;
v. The duration of the Restrictive ProcedureIntervention; and
vi. The Participant’s condition during and following the removal of the Restrictive ProcedureIntervention.
Appears in 1 contract
Functions and Duties of the Contractor. The Contractor shall:
A. Provide or arrange for the delivery of all Authorized Services to each Participant for the term of the Participant's enrollment.
B. Conduct assessments using the instruments and at the frequency specified by the Department, including the assessments identified in Appendix A.
C. Maintain a record for each Participant and require its Network Providers to maintain a record for each Participant.
1. The record maintained by each Network Provider must document all care provided and comply with the requirements specified in the Department's Medical Assistance regulations that are appropriate to the standard of care for that Provider.
2. The Contractor's record for each Participant must include, at a minimum, the following:
a. Identification of the Participant on each page
b. Identifying demographic information
c. A complete medical history
d. The Participant's complaints accompanied by the Contractor's findings
e. A preliminary working diagnosis as well as a final diagnosis based on the Participant's history and examination
f. Documentation of all services provided, including documentation of the medical necessity of a rendered, ordered, or prescribed service
g. Multi-disciplinary assessments, reassessments, plans of care, treatment and progress notes
h. Drugs prescribed as part of the treatment, including the quantities and dosage, and if the prescription was telephoned to a pharmacist i. Lab reports, including interpretations of diagnostic tests and reports of consultations
j. Hospital discharge records
k. Reports from the Contractor and Providers
l. Contacts with informal supports (Participant's family, friends, church, etc.)
m. The Participant's signed Enrollment Agreement, which includes a Agreement and signed statement that verifying the Participant Participant's or, if appropriate, the Participant's representative's, received review and receipt of the Participant Handbook and the Participant Handbook was reviewed with the Participant or, if appropriate, the Participant’s representativeHandbook
n. Physician orders
o. The Participant’s ISP, including if developed for the Participant, the Behavioral Support Plan, the Crisis Intervention Plan and the Restrictive Procedure Intervention Plan, and the Contingency Plan for each service in the ISP, and all updates and revisions to the ISP and Contingency Plan
p. The Participant’s Skill Building Plan, if developed for the Participant, and all updates and revisions to the Skill Building Plan q. The Participant’s Medication Therapeutic Management Plan, if developed for the Participant, and all updates and revisions to the Medication Therapeutic Management Plan
r. The Participant’s Restrictive Procedure Intervention Plan, the signatures of the members of the Human Rights Team that approved the Restrictive Procedure Intervention Plan, and a record of each use of a Restrictive Procedure Intervention that includes the following (when applicable for non-physical Restrictive ProceduresInterventions, i.e., medication box, money safe):
i. Documentation of the specific behavior addressed through the use of the Restrictive ProcedureIntervention;
ii. The method or procedure of Restrictive Procedure usedIntervention used and the behavior addressed by the Restrictive Intervention;
iii. The date and time the Restrictive Procedure Intervention was used;
iv. The staff person who used the Restrictive ProcedureIntervention;
v. The duration of the Restrictive ProcedureIntervention; and
vi. The Participant’s condition during and following the removal of the Restrictive ProcedureIntervention.
Appears in 1 contract
