Common use of MCO Responsibilities Clause in Contracts

MCO Responsibilities. When the MCO becomes aware that a member intends to change the member’s residence, the MCO shall, in addition to updating its records when the change of address occurs, do the following: For Moves Within the Geographic Service Region: Inform the member of any changes in IDT staff, service providers or other aspects of the member's care plan that may result from the move. Complete Section D of the Family Care /Partnership /PACE Change Routing Form per instructions. The form is available at Family Care/Partnership/PACE/IRIS - Change Routing Form (F- 02404). Do not disenroll the member; only a transfer of Medicaid eligibility between income maintenance consortia is necessary if applicable. For Moves to Another Geographic Service Region Served by the MCO: Inform the member of any changes in IDT staff, service providers or other aspects of the member's care plan that will result from the move. Complete Section D of the Family Care /Partnership /PACE Change Routing Form per instructions. The form is available at Family Care/Partnership/PACE/IRIS - Change Routing Form (F- 02404). Do not disenroll the member; only a transfer of Medicaid eligibility between income maintenance consortia is necessary if applicable. Inform the member that options counseling is available from the ADRC or Tribal ADRS (if applicable) in the county to which the member is moving should the member wish to consider a change in MCO (if another MCO operates in the geographic service region) or in long-term care program. For Moves to Another Geographic Service Region Not Served by the MCO: Unless the move is due to an MCO-initiated placement in a nursing home or community residential facility, inform the member that she or he will be disenrolled, will need to select a different MCO, and that the IDT staff will help with this transition. Explain to the member that to assure uninterrupted services, and in the case of a member in the special home and community-based waiver eligibility group (Group B or B+) uninterrupted Medicaid eligibility, it is necessary to contact the ADRC or Tribal ADRS (if applicable) in the new county of residence to enroll in another MCO or another long-term care program, preferably with the same effective date as the disenrollment from the current MCO. The MCO should facilitate this contact and coordinate disenrollment/enrollment dates with the receiving ADRC or Tribal ADRS (if applicable). Complete Section D of the Family Care /Partnership /PACE Change Routing Form per instructions, initiating disenrollment. The form is available at Family Care/Partnership/PACE/IRIS - Change Routing Form (F-02404). Requirement to Notify Counties and Tribal Human/Human and Family Services of At-Risk Members:‌ If an MCO identifies risk factors for a member that indicate a need to coordinate planning efforts or provide information to a county and tribal Human Services agency, the MCO will do the following: Send the Family Care Member County Notification Form F-02558 xxxxx://xxx.xxx.xxxxxxxxx.xxx/forms/f02558.docx to: The county of residence/responsibility on record, To the county where the person lives (if different), and To the tribal Human/Human and Family Services agency. When appropriate or requested, work with the receiving county, tribal Human/Human and Family Services agency, and any relevant providers in the development of a behavior support plan, a crisis plan, or other community safety plans. Update the information on form F-02558 if the member’s address or other essential information changes, and provide that information to the county and tribal Human/Human and Family Services agency. If the member lives in a residential setting, provide a copy of the notification form to the member’s residential provider agency.

MCO Responsibilities. When the MCO becomes aware that a member intends to change the member’s her or his residence, the MCO shall, in addition to updating its records when the change of address occurs, do the following: For Moves Within the Geographic Service Region: Inform the member of any changes in IDT staff, service providers or other aspects of the member's care plan that may result from the move. Complete Section D of the Family Care /Partnership /PACE Change Routing Form per instructions. The form is available at Family Care/Partnership/PACE/IRIS - Change Routing Form (F- 0240400221A). The instructions are at Family Care/Partnership/PACE/IRIS - Change Routing Instructions (F- 00221AI). Do not disenroll the member; only a transfer of Medicaid eligibility between income maintenance consortia is necessary if applicable. For Moves to Another Geographic Service Region Served by the MCO: Inform the member of any changes in IDT staff, service providers or other aspects of the member's care plan that will result from the move. Complete Section D of the Family Care /Partnership /PACE Change Routing Form per instructions. The form is available at Family Care/Partnership/PACE/IRIS - Change Routing Form (F- 0240400221A). The instructions are at Family Care/Partnership/PACE/IRIS - Change Routing Instructions (F- 00221AI). Do not disenroll the member; only a transfer of Medicaid eligibility between income maintenance consortia is necessary if applicable. Inform the member that options counseling is available from the ADRC or Tribal ADRS (if applicable) in the county to which the member is moving should the member wish to consider a change in MCO (if another MCO operates in the geographic service region) or in long-long term care program. For Moves to Another Geographic Service Region Not Served by the MCO: Unless the move is due to an MCO-initiated placement in a nursing home or community residential facility, inform the member that she or he will be disenrolled, will need to select a different MCO, and that the IDT staff will help with this transition. Explain to the member that to assure uninterrupted services, and in the case of a member in the special home and community-based waiver eligibility group (Group B or B+) uninterrupted Medicaid eligibility, it is necessary to contact the ADRC or Tribal ADRS (if applicable) in the new county of residence to enroll in another MCO or another long-long term care program, preferably with the same effective date as the disenrollment from the current MCO. The MCO should facilitate this contact and coordinate disenrollment/enrollment dates with the receiving ADRC or Tribal ADRS (if applicable)ADRC. Complete Section D of the Family Care /Partnership /PACE Change Routing Form per instructions, initiating disenrollment. The form is available at Family Care/Partnership/PACE/IRIS - Change Routing Form (F-02404F-00221A). Requirement to Notify Counties and Tribal HumanThe instructions are at Family Care/Human and Family Services of At-Risk Members:‌ If an MCO identifies risk factors for a member that indicate a need to coordinate planning efforts or provide information Partnership/PACE/IRIS - Change Routing Instructions (F- 00221AI). For Moves to a county and tribal Human Services agency, the MCO will do the following: Send County without the Family Care Member County Notification Form F-02558 xxxxx://xxx.xxx.xxxxxxxxx.xxx/forms/f02558.docx toBenefit: The county of residence/responsibility on recordUnless the move is due to an MCO-initiated placement in a nursing home or community residential facility, To inform the member that she or he will be disenrolled and lose eligibility for Family Care. Explain to the member that the Family Care benefit is not available in the county where to which the person lives (if different)member intends to move. Explain that it is likely, and To the tribal Human/Human and Family Services agency. When appropriate or requestedbut not certain, work with that the receiving countycounty can provide services to the member through another program, tribal Human/Human but if it cannot she or he may be placed on waiting list for home and Family Services agency, community- based services; and any relevant providers that if the member is in the development of special home and community-based waiver eligibility group (Group B or B+) the member will lose Medicaid eligibility while on a behavior support plan, a crisis plan, or other community safety plans. Update the information on form F-02558 if the member’s address or other essential information changes, and provide that information to the county and tribal Human/Human and Family Services agencywaiting list. If the member lives will move, complete Section D of the Family Care /Partnership /PACE Change Routing Form per instructions, initiating disenrollment. The form is available at Family Care/Partnership/PACE/IRIS - Change Routing Form (F-00221A). The instructions are at Family Care/Partnership/PACE/IRIS - Change Routing Instructions (F-00221AI) Advise the member to contact the ADRC in the receiving county for information and assistance. Coordinate Family Care disenrollment with enrollment in a residential setting, provide legacy waiver program or placement on a copy of waiting list with the notification form to ADRC in the member’s residential provider agencyreceiving county.

MCO Responsibilities. When the MCO becomes aware that a member intends to change the member’s her or his residence, the MCO shall, in addition to updating its records when the change of address occurs, do the following: For Moves Within the Geographic Service Region: Inform the member of any changes in IDT staff, service providers or other aspects of the member's care plan that may result from the move. Complete Section D of the Family Care /Partnership /PACE Change Routing Form per instructions. The form is available at Family Care/Partnership/PACE/IRIS - Change Routing Form (F- 02404). Do not disenroll the member; only a transfer of Medicaid eligibility between income maintenance consortia is necessary if applicable. For Moves to Another Geographic Service Region Served by the MCO: Inform the member of any changes in IDT staff, service providers or other aspects of the member's care plan that will result from the move. Complete Section D of the Family Care /Partnership /PACE Change Routing Form per instructions. The form is available at Family Care/Partnership/PACE/IRIS - Change Routing Form (F- 02404). Do not disenroll the member; only a transfer of Medicaid eligibility between income maintenance consortia is necessary if applicable. Inform the member that options counseling is available from the ADRC or Tribal ADRS (if applicable) in the county to which the member is moving should the member wish to consider a change in MCO (if another MCO operates in the geographic service region) or in long-long term care program. For Moves to Another Geographic Service Region Not Served by the MCO: Department Review‌‌ Unless the move is due to an MCO-initiated placement in a nursing home or community residential facility, inform the member that she or he will be disenrolled, will need to select a different MCO, and that the IDT staff will help with this transition. Explain to the member that to assure uninterrupted services, and in the case of a member in the special home and community-based waiver eligibility group (Group B or B+) uninterrupted Medicaid eligibility, it is necessary to contact the ADRC or Tribal ADRS (if applicable) in the new county of residence to enroll in another MCO or another long-long term care program, preferably with the same effective date as the disenrollment from the current MCO. The MCO should facilitate this contact and coordinate disenrollment/enrollment dates with the receiving ADRC or Tribal ADRS (if applicable)ADRC. Complete Section D of the Family Care /Partnership /PACE Change Routing Form per instructions, initiating disenrollment. The form is available at Family Care/Partnership/PACE/IRIS - Change Routing Form (F-02404). Requirement to Notify Counties and Tribal Human/Human and Family Services The Department will review the performance of At-Risk Members:‌ If an MCO identifies risk factors for a member that indicate a need to coordinate planning efforts or provide information to a county and tribal Human Services agency, the MCO will do and its staff in carrying out the following: Send the Family Care Member County Notification Form F-02558 xxxxx://xxx.xxx.xxxxxxxxx.xxx/forms/f02558.docx to: care management functions specified in this article. The county of residence/responsibility on record, To the county where the person lives (if different), and To the tribal Human/Human and Family Services agency. When appropriate or requested, work with the receiving county, tribal Human/Human and Family Services agency, MCO shall make readily available member records and any relevant providers other materials the Department deems necessary for such reviews in the development of a behavior support planaccordance with Article XIII.J., a crisis plan, or other community safety plans. Update the information on form F-02558 if the member’s address or other essential information changes, Access to Premises and provide that information to the county and tribal Human/Human and Family Services agency. If the member lives in a residential setting, provide a copy of the notification form to the member’s residential provider agencyInformation.

MCO Responsibilities. When the MCO becomes aware that a member intends to change the member’s her or his residence, the MCO shall, in addition to updating its records when the change of address occurs, do the following: For Moves Within the Geographic Service Region: Inform the member of any changes in IDT staff, service providers or other aspects of the member's care plan that may result from the move. Complete Section D of the Family Care /Partnership /PACE Change Routing Form per instructions. The form is available at Family Care/Partnership/PACE/IRIS - Change Routing Form (F- 02404). Do not disenroll the member; only a transfer of Medicaid eligibility between income maintenance consortia is necessary if applicable. For Moves to Another Geographic Service Region Served by the MCO: Inform the member of any changes in IDT staff, service providers or other aspects of the member's care plan that will result from the move. Complete Section D of the Family Care /Partnership /PACE Change Routing Form per instructions. The form is available at Family Care/Partnership/PACE/IRIS - Change Routing Form (F- 02404). Do not disenroll the member; only a transfer of Medicaid eligibility between income maintenance consortia is necessary if applicable. Inform the member that options counseling is available from the ADRC or Tribal ADRS (if applicable) in the county to which the member is moving should the member wish to consider a change in MCO (if another MCO operates in the geographic service region) or in long-long term care program. For Moves to Another Geographic Service Region Not Served by the MCO: Unless the move is due to an MCO-initiated placement in a nursing home or community residential facility, inform the member that she or he will be disenrolled, will need to select a different MCO, and that the IDT staff will help with this transition. Explain to the member that to assure uninterrupted services, and in the case of a member in the special home and community-based waiver eligibility group (Group B or B+) uninterrupted Medicaid eligibility, it is necessary to contact the ADRC or Tribal ADRS (if applicable) in the new county of residence to enroll in another MCO or another long-long term care program, preferably with the same effective date as the disenrollment from the current MCO. The MCO should facilitate this contact and coordinate disenrollment/enrollment dates with the receiving ADRC or Tribal ADRS (if applicable). Complete Section D of the Family Care /Partnership /PACE Change Routing Form per instructions, initiating disenrollment. The form is available at Family Care/Partnership/PACE/IRIS - Change Routing Form (F-02404). Requirement to Notify Counties and Tribal Human/Human and Family Services of At-Risk Members:‌ Members: If an MCO identifies risk factors for a member that indicate a need to coordinate planning efforts or provide information to a county and tribal Human Services agency, the MCO will do the following: Send the Family Care Member County Notification Form F-02558 xxxxx://xxx.xxx.xxxxxxxxx.xxx/forms/f02558.docx to: The county of residence/responsibility on record, To the county where the person lives (if different), and To the tribal Human/Human and Family Services agency. When appropriate or requested, work with the receiving county, tribal Human/Human and Family Services agency, and any relevant providers in the development of a behavior support plan, a crisis plan, or other community safety plans. Update the information on form F-02558 if the member’s address or other essential information changes, and provide that information to the county and tribal Human/Human and Family Services agency. If the member lives in a residential setting, provide a copy of the notification form to the member’s residential provider agency.