Common use of MCO Requirements Clause in Contracts

MCO Requirements. The MCO must present SDS as a choice to all members as specified in s DHS 10.44(6) Wis. Admin. Code. Specific responsibilities of the MCO are to: 1. Ensure that SDS funds are not used to purchase residential services that are included as part of a bundled residential services rate in a long-term care facility. Members who live in residential settings can self-direct services that are not part of the residential rate. The cost of residential services may be used in establishing the member’s SDS budget if the MCO would have authorized residential services for the member if the member were not participating in SDS. 2. Continue to expand the variety of choices and supports available within SDS. 3. Ensure that all IDT staff understand SDS, how to create a budget with a member and how to monitor SDS with a member and their support team, or ensure team staff have access to someone within the MCO who has expertise in SDS to assist with setting budgets and monitoring for quality and safety. 4. Collaborate with the Department in its efforts to develop systems for evaluating the quality of SDS, including members’ experiences with SDS. 5. Develop and implement a Department-approved policy and procedure describing conditions under which the MCO may restrict the level of self-management exercised by a member where the team finds any of the following: a. The health and safety of the member or another person is threatened. b. The member’s expenditures are inconsistent with the established plan and budget. c. The conflicting interests of another person are taking precedence over the outcomes and preferences of the member. d. Funds have been used for illegal purposes. e. Additional criteria for restricting the level of self-management exercised by a member may be approved by the Department in relation to other situations that the MCO has identified as having negative consequences. The MCO’s policy and procedure for limiting SDS shall be submitted to the Department for approval prior to implementation, whenever a change occurs, and upon request. The MCO shall share SDS materials with the resource centers in their service areas that will allow the resource centers to provide appropriate options counseling about the SDS option to potential enrollees.

MCO Requirements. The MCO must present SDS as a choice to all members as specified in s DHS 10.44(6) Wis. Admin. CodeCode § DHS 10.44(6). Specific responsibilities of the MCO are to: 1. Ensure that SDS funds are not used to purchase residential services that are included as part of a bundled residential services rate in a long-term care facility. Members who live in residential settings can self-direct services that are not part of the residential rate. 2. The Determine the cost of residential services may to be self-directed, which shall be used in establishing the member’s 's SDS budget if the MCO would have authorized residential services for the member if the member were not participating in SDSbudget. 23. Continue to expand the variety of choices and supports available within SDS. 34. Ensure that all IDT staff understand SDS, how to create a budget with a member and how to monitor SDS with a member and their support team, or ensure team staff have access to someone within the MCO who has expertise in SDS to assist with setting budgets and monitoring for quality and safety. 45. Collaborate with the Department in its efforts to develop systems for evaluating the quality of SDS, including members’ experiences with SDS. 56. Develop and implement a Department-approved policy and procedure describing conditions under which the MCO may restrict the level of self-management exercised by a member where the team finds any of the following: a. The health and safety of the member or another person is threatened. b. The member’s expenditures are inconsistent with the established plan and budget. c. The conflicting interests of another person are taking precedence over the outcomes and preferences of the member. d. Funds have been used for illegal purposes. e. Additional criteria for restricting the level of self-management exercised by a member may be approved by the Department in relation to other situations that the MCO has identified as having negative consequences. The MCO’s policy and procedure for limiting SDS shall be submitted to the Department for approval prior to implementation, whenever a change occurs, and upon request. The MCO shall share SDS materials with the resource centers in their service areas that will allow the resource centers to provide appropriate options counseling about the SDS option to potential enrollees.

MCO Requirements. The MCO must present SDS as a choice to all members as specified in s DHS 10.44(6) Wis. Admin. CodeCode § DHS 10.44(6). Specific responsibilities of the MCO are to: 1. Ensure that SDS funds are not used to purchase residential services that are included as part of a bundled residential services rate in a long-term care facility. Members who live in residential settings can self-direct services that are not part of the residential rate. 2. The Determine the cost of residential services may to be self-directed, which shall be used in establishing the member’s 's SDS budget if the MCO would have authorized residential services for the member if the member were not participating in SDSbudget. 23. Continue to expand the variety of choices and supports available within SDS. 34. Ensure that all IDT staff understand SDS or have access to MCO staff who have expertise in SDS, . 5. Ensure that all IDT staff understand how to create a budget with a member and or have access to MCO staff who have expertise in SDS who can assist with setting budgets. 6. Ensure that all IDT staff understand how to monitor SDS with a member and their support team, IDT or ensure team staff have access to someone within the MCO staff who has have expertise in SDS to who can assist with setting budgets and monitoring for quality and safety. 47. Ensure that all IDT staff understand how to mitigate the potential conflicts inherent when a legal decision maker is self-directing on behalf of the member or have access to MCO staff who have expertise in SDS who can assist with mitigating such conflicts. 8. Collaborate with the Department in its efforts to develop systems for evaluating the quality of SDS, including members’ experiences with SDS. 59. Develop and implement a Department-approved policy and procedure describing conditions under which the MCO may restrict the level of self-management exercised by a member where the team finds any of the following: a. The health and safety of the member or another person is threatened. b. The member’s expenditures are inconsistent with the established plan and budget. c. The conflicting interests of another person are taking precedence over the outcomes and preferences of the member. d. Funds have been used for illegal purposes. e. The member has been identified as a Vulnerable/High Risk member and insufficient measures have been taken to mitigate risk. f. The member refuses to provide access to the home or otherwise refuses to provide information necessary for the IDT to adequately monitor member health and safety. g. Additional criteria for restricting the level of self-management exercised by a member may be approved by the Department in relation to other situations that the MCO has identified as having negative consequences. The MCO’s policy and procedure for limiting SDS shall be submitted to the Department for approval prior to implementation, whenever a change occurs, and upon request. The MCO shall share SDS materials with the resource centers in their service areas that will allow the resource centers to provide appropriate options counseling about the SDS option to potential enrollees. 10. Assure that persons providing services to members on a self-directed basis who do not otherwise have worker’s compensation coverage for those services have coverage provided as follows: a. Where the member is the common law employer of the person providing services, the fiscal services management entity (also called the fiscal/employer agent) that performs employer-related tasks for the member shall purchase and manage a worker's compensation policy on behalf of the member, who shall be the worker's compensation employer. b. Where the member is the managing co-employer of the person providing services with a co-employment agency (also called an agency with choice) as the common law employer, the co-employment agency shall provide worker’s compensation coverage as the worker’s compensation employer.