General Care Coordination Requirements Sample Clauses

General Care Coordination Requirements. A. The CONTRACTOR shall: i. Provide statewide care coordination, either directly or through subcontractors, for SALUD! Members with multiple and complex special physical, mental and behavioral health care needs. ii. Provide as part of their care coordination program, the six targeted case management programs included in the SALUD! Benefit package, on a statewide basis, and be held accountable for delivering these services according to MAD policy. iii. Develop and implement written policies and procedures, approved by HSD, which govern how members with multiple and complex special physical, mental and behavioral health care needs shall be identified. iv. Develop and implement written policies and procedures, approved by HSD, governing how care coordination shall be provided for members. These shall address the development of member's individual treatment plan, based on a comprehensive assessment of the goals, capacities and medical condition of the member, and the needs and goals of the family; and criteria for evaluating a member's response to care and revising the plan, as indicated. A member and family shall be involved in the development of the treatment plan, as appropriate. A member or family shall have a right to refuse care coordination or case management. v. Develop and implement policies and procedures which define care coordination, including the targeted case management programs, according to MAD policy on each; specify that care coordinators/case managers shall meet with members on a regular, face-to-face basis, as is indicated. Telephonic contacts alone do not meet the requirements of the six specific case management programs, or of care coordination services. vi. Specify how care coordination shall be supported by an internal information system. vii. Develop and implement policy and procedures to establish working relationships between care coordinators and providers. viii. Continue to work with the Medicaid in the Schools (MITS) program providers to identify and coordinate with the child's SALUD! primary care provider (PCP). B. Specific Coordination Requirements i. Initial Written Referral Report. A written report of the outcome of any referral, containing sufficient information to coordinate the member's care, shall be forwarded to the PCP by the behavioral health provider within seven (7) calendar days after the screening and evaluation visit.
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