Initial Measure. A workplan that identifies the plan’s strengths and areas for improvement in the above stated goal, a proposed corrective action plan, and the method that will be utilized by the plan to evaluate the effectiveness of the activities The workplan shall identify how the plan will incorporate the Department’s lock-in procedures into business operations. The plan shall identify any training protocols, and staff responsible for coordinating the above issue with the Department. The workplan shall demonstrate how the plan shall inform staff and providers of the procedure. The plan shall include any proposed methods of educating the client about the requirement. The initial workplan shall be submitted and approved by the Department prior to July, 1999. The plan’s internal operations manual addressing the requirements shall be included with the initial workplan.
Initial Measure. A workplan that identifies the plan’s strengths and areas for improvement in the above stated goal, a proposed corrective action plan, and the method that will be utilized by the plan to evaluate the effectiveness of the activities The workplan shall describe how the plan will coordinate the PHN functions with the PCP and specialty/ancillary providers in the plan’s network, as well as the plan’s member services and case management components. The workplan shall describe the plan’s ability to coordinate activities with the PHN, and how the plan proposes to utilize the information provided, e.g., outreach, coordination with member services, case management, disease state management, coordination with the PCP, client education, etc. The workplan shall identify staff responsible for the receipt, operationalization of the information and a flowchart describing how the information will be shared among the staff and providers. The plan should also identify how it will communicate with the EBS on the receipt of the information, and coordination of case management issues. The workplan shall demonstrate the plan’s understanding of the PHN concept and how it will train staff and providers in operationalizing the coordination of healthcare and social issues with the PHN. The initial workplan shall address the first two years of the contract, and shall be submitted and approved by the Department prior to July, 1999. The plan’s internal operations manual addressing the requirements shall be included with the initial workplan.
Initial Measure. A workplan that identifies the plan's strengths and areas for improvement in the above stated goal, a proposed corrective action plan, and the method that will be utilized by the plan to evaluate the effectiveness of the activities. The workplan shall address the plan's proposed activities such as cultural sensitivity training for staff and providers, participation in/sponsorship of community events, increased numbers of culturally diverse staff and providers, etc. The workplan shall include specific activities, dates/times, targeted audiences, and designated staff responsible for the activity. The initial workplan shall address the first two years of the contract, and shall be submitted and approved by the Department prior to July, 1999. Proposed printed materials shall be included as part of the workplan, along with a timetable for development and printing that incorporates the requirement for review by the Department, and an anticipated distribution plan.
Initial Measure. A workplan that identifies the plan's strengths and areas for improvement in the above stated goal, a proposed corrective action plan, and the method that will be utilized by the plan to evaluate the effectiveness of the activities. The workplan shall include specific activities such as additional education opportunities or printed materials that address the appropriate use of managed care. The workplan shall describe how the plan will incorporate the special needs of the Medicaid population into the plan's operational and management activities such as "flexible" referral/prior authorization requirements, enhanced case management activities, and coordination activities with the EBS. The workplan shall include specific activities, dates/times, targeted audiences, and designated staff responsible for the activity. The workplan shall also address the enhanced procedures required for the enrollment of clients in the blind/disabled categories, and the departmental xxxx/xxxxxx care categories pursuant to Section 9.5 of this contract. The initial workplan shall address the plan's proposed activities for the first two years of the contract, and shall be submitted and approved by the Department prior to July, 1999. Proposed printed materials shall be included as part of the workplan, along with a timetable for development and printing that includes the requirement for review by the Department, and an anticipated distribution plan.
Initial Measure. A workplan that identifies the plan's strengths and areas for improvement in the above stated goal, a proposed corrective action plan, and the method that will be utilized by the plan to evaluate the effectiveness of the activities. The workplan shall address the challenges of working with the Medicaid population, given the movement of the average client in and out of Medicaid and the NHC. Include how these approaches will be incorporated into the plan's operational and management activities such as training for staff and providers, enhanced care management functions, innovative ways to promote continuity of care, and maintenance/coordination of medical records/medical history, etc. The workplan shall include specific activities, dates/times, targeted audiences, and designated staff responsible for the activity. The workplan shall also address the enhanced procedures required for clients who are re-enrolled with the same PCP/plan within two months of disenrollment pursuant to Section 9.4 of this contract. The initial workplan shall address the plan's proposed activities for the first two years of the contract, and shall be submitted and approved by the Department prior to July, 1999. Proposed printed materials shall be included as part of the workplan, along with a timetable for development and printing that includes the requirement for review by the Department, and an anticipated distribution plan.
Initial Measure. A workplan that identifies the plan's strengths and areas for improvement in the above stated goal, a proposed corrective action plan, and the method that will be utilized by the plan to evaluate the effectiveness of the activities. The workplan shall identify how the plan will incorporate use of the NHC forms and related procedures into its daily operations. The sharing of information, e.g., insurance, Medicare, birth information, waiver of enrollment/disenrollment-related issues, etc., is critical to the accurate reporting and determination of managed care participation. The plan shall identify its training protocols for staff on how the forms will be used, key contact personnel responsible for the efficient flow of information, and how the plan will evaluate the effectiveness of the NHC processes. The initial workplan shall be submitted and approved by the Department prior to July, 1999. The plan's internal operations manual addressing the requirements shall be included with the initial workplan.
Initial Measure. A workplan that identifies the plan's strengths and areas for improvement in the above stated goal, a proposed corrective action plan, and the method that will be utilized by the plan to evaluate the effectiveness of the activities. The workplan shall identify key enrollment information such as member and provider handbooks, description of the benefit package, member services, provider directories, specialty/ancillary services, etc. The workplan shall describe how the plan will determine the needs of the client, e.g., reading level, languages, enhanced methods of availability such as Braille, audio, video, etc., and that the materials are meeting the needs on an ongoing basis. The workplan shall include specific activities that it will utilize to determine the types/methods of communication required, e.g., census data, surveys of client population, work with advocate groups, etc., the appropriateness of the materials, e.g., focus groups, subcontracts for translations and interpreters, etc., and the designated staff responsible for the activity. The initial workplan shall address the plan's proposed activities for the first two years of the contract, and shall be submitted and approved by the Department prior to July, 1999. Proposed printed materials shall be included as part of the workplan, along with a timetable for development and printing that includes the requirement for review by the Department, and an anticipated distribution plan.
Initial Measure. A workplan that identifies the plan's strengths and areas for improvement in the above stated goal, a proposed corrective action plan, and the method that will be utilized by the plan to evaluate the effectiveness of the activities. The workplan shall describe the plan's benefits, programs, case management, member services and follow-up care for a pregnant woman and her unborn/newborn. The workplace should describe how the plan will incorporate the following, and similar, unique aspects of Nebraska Medicaid:
(a) Where pregnancy-related services (e.g., prenatal, delivery and postpartum care) may require "open-ended" referrals for the mother for pregnancy-related services by the plan to a PCP specializing in obstetrics/gynecology (i.e., in situations where the mother receives services through the "eligibility" of her unborn who is enrolled with a pediatrician);
(b) The splitting of claims between the traditional fee-for-service system and the plan, if the actual enrollment of the pregnant mother/unborn occurs during the time period the package of pregnancy-related services are provided;
(c) Multiple births; and
(d) Out-of-network deliveries. The workplan shall also include a description of what measures the plan will utilize to ensure the following, and similar, situations:
(a) Early entry into prenatal care;
(b) Assistance for the pregnant woman to overcome various obstacles to obtaining prenatal care (e.g., lack of transportation, communication/language barriers, deafness, cultural barriers such as the woman cannot have a male examiner; and child care issues);
(c) Prenatal preventative health education programs or materials plan; and
(d) Referral system for, and provision of, non-obstetric problems that may develop during the course of the pregnancy, e.g., other medical conditions, mental health and substance abuse problems, social issues such as homelessness, domestic violence, etc. The workplan shall include specific activities, educational or other marketing approaches that will be utilized and the designated staff responsible for the activity. The initial workplan shall address the plan's proposed activities for the first two years of the contract, and shall be submitted and approved by the Department prior to July, 1999. Proposed printed materials shall be included as part of the workplan, along with a timetable for development and printing that includes the requirement for review by the Department, and an anticipated distribution plan.
Initial Measure. A workplan that identifies the plan's strengths and areas for improvement in the above stated goal, a proposed corrective action plan, and the method that will be utilized by the plan to evaluate the effectiveness of the activities. The workplan shall identify how the plan will incorporate inclusion of legal representatives, advocates and HHS staff in the NHC activities. The plan shall identify its training protocols for staff and providers on this provision and how the plan will evaluate the effectiveness of the requirement, and the plan's ability to work with the Medicaid client and others who are legally, or otherwise, responsible for assisting the client in the coordination of care and problem-resolution. The plan should identify staff responsible for coordinating such efforts The workplan shall identify any business protocols that address the above requirement and the extent to which the plan will go to work with the Medicaid population in resolving issues, and coordinating efforts with others involved with the client. The plan should also address applicable policies on confidentiality, case management, member services and how it will incorporate the concepts into its daily operations. The initial workplan shall be submitted and approved by the Department prior to July, 1999. The plan's internal operations manual addressing the requirements shall be included with the initial workplan.
Initial Measure. A workplan that identifies the plan's strengths and areas for improvement in the above stated goal, a proposed corrective action plan, and the method that will be utilized by the plan to evaluate the effectiveness of the activities. The workplan shall demonstrate how the plan shall inform staff and providers of the Department's notification process to ensure that staff and providers are able to verify eligibility at the time of service. The plan shall include any proposed methods of educating the client about managed care eligibility and the importance of carrying the Identification Document as verification of managed care participation. Describe the plan and provider's ability to access eligibility either through the plan's procedures or by utilizing the Department's automated NMES line. Include routine and non- routine procedures the client should follow to access both the plan and PCP, and how this will be communicated to the client and provider. The workplan shall demonstrate how the plan shall inform staff and providers of the Department's notification process to ensure that staff and providers are able to verify eligibility at the time of service. The plan shall include any proposed methods of educating the client about managed care eligibility and the importance of carrying the Identification Document as verification of managed care participation. Describe the plan and provider's ability to access eligibility either through the plan's procedures or by utilizing the Department's automated NMES line. Include routine and non- routine procedures the client should follow to access both the plan and PCP, and how this will be communicated to the client and provider. The workplan shall also demonstrate the plan's procedure and method of notification to the client on the approval, denial or reduction of a service. The initial workplan shall be submitted and approved by the Department prior to July, 1999. The plan's internal operations manual addressing the requirements shall be included with the initial workplan.
