Common use of Initial Contact--Identification of Enrollees with Special Health Care Needs Clause in Contracts

Initial Contact--Identification of Enrollees with Special Health Care Needs. (A) The Contractor shall establish a policy which shall be used by Contractor’s representative during the initial contact to identify children and adults with Special Health Care Needs. (B) During the initial contact, the Contractor’s representative shall clearly describe to each Enrollee the process for requesting specialist care. (C) When an Enrollee is identified as having Special Health Care Needs, the Contractor’s representative shall forward this information to a Contractor’s individual with knowledge of coordination of care, case management services, and other services necessary for such Enrollees. The Contractor’s individual with knowledge of coordination of care for Enrollees with Special Health Care Needs shall make a good faith effort to contact such Enrollees within ten working days after identification to begin coordination of dental care needs, if necessary. (D) The Department’s Health Program Representatives will document information, including risk assessments that identify Enrollees with Special Health Care Needs and limited language proficiency needs. Such information will coincide with the daily Eligibility Transmission whenever possible. The Contractor shall be responsible for accessing this information on the Medicaid Managed Care System (MMCS).