Integrated Design for Care Management Sample Clauses

Integrated Design for Care Management. 1. The Contractor shall submit to EOHHS a work plan for the Contract Year, including timelines, for providing ongoing support for PBCM programs and providing integrated care management for Enrollees served in ICMP. The work plan shall include the supports offered by the Contractor’s care management staff related to care management activities provided by PBCMs. 2. The work plan shall be submitted, for review and approval, within two months of the first day of the current Contract Year. This work plan shall: a. Prioritize direct real-time referrals to ICMP for high risk Enrollees not served by PBCM programs; b. Describe the process of referring Enrollees from ICMP to PBCMs, where appropriate; c. Include a description and process for Care Coordination activities within ICMP for those Enrollees in need of primary complex Care Coordination; d. Address care management services for those Enrollees transitioning to the community from long term support services; e. Address the expansion of PBCM and plan-based programs throughout the Commonwealth to provide care management for Enrollees identified by the Contractor as high risk and eligible for care management, including ICMP among members for whom PBCM is not available; f. Include the supports and services offered by the Contractor to Providers who request support from the Contractor for their care management program; g. Include an ICMP staffing plan with that includes professional licensed staff, Certified Mental Health Peer Specialists, Recovery Coaches, and community health workers, including the functions to be performed by para-professional staff under the clinical supervision of licensed clinical staff. Licensed staff includes Behavioral Health clinicians and nurses. All ICMP para-professional staff shall be employed directly by the Contractor; h. Include the functions of the PCC Support Managers as an ICMP team member; and i. Include proposals to provide ICMP to high risk populations other than Enrollees who are pregnant or postpartum. 3. Within three months of the first day of the current Contract Year, the Contractor shall submit to EOHHS any updates in the policies and procedures for daily operation of the care management program. 4. The Contractor shall specifically tailor the care management provided to improve the health outcomes of each Participant, including such items as the frequency and intensity of interventions, and ensuring that the staff assigned to the Participant is appropriate based on each...