Common use of MDS-HC Assessment Clause in Contracts

MDS-HC Assessment. The Contractor must complete MDS‑HC assessments for its Enrollees as described below. The MDS‑HC must be completed in‑person by a registered nurse. Information collected on the MDS‑HC must be sent to MassHealth via the MDS‑HC application in the Commonwealth’s Virtual Gateway to ensure accurate assignment of Rating Categories. The Contractor must cooperate with and participate in any and all requests made by MassHealth for further information concerning any MDS‑HC submission. The MDS‑HC must be completed as follows: For Enrollees assigned to the C1 Rating Category, the MDS‑HC must be completed to change the Rating Category; For Enrollees assigned to the C2 Rating Categories, including C2A and C2B, the MDS‑HC must be completed within 90 days of the Enrollee’s Effective Enrollment Date into One Care, and at least annually thereafter; For Enrollees assigned to the C3 Rating Categories, including C3A and C3B, the MDS‑HC must be completed within 90 days of the Enrollee’s Effective Enrollment Date into One Care and at least annually thereafter; For Enrollees assigned to the C4 Rating Category, the MDS‑HC must be completed: Within thirty (30) days following the Enrollee’s admission into a Transitional Living Program; and Prior to the end of the month of discharge from a Transitional Living Program; In order to change any Enrollee’s Rating Category to a Rating Category, other than the F1 Rating Category based on the Enrollee’s current residence in a long‑term care facility for at least ninety (90) days. The Contractor shall: Engage each Enrollee in ongoing development of their ICP. Ensure that the ICT integrates and coordinates services, including, but not limited to engaging each Enrollee in the development of an ICP. The ICP must: Incorporate the results of the Comprehensive Assessment and specify any changes in providers, services, or medications. Be developed by the ICT under the direction of the Enrollee (and/or the Enrollee’s representative, if applicable), and in consultation with any specialists caring for the Enrollee, in accordance with 42 C.F.R. 438.208(c)(3) and 42 C.F.R. 422.112(a)(6)(iii) and updated periodically to reflect changing needs identified in Comprehensive Assessments. The Enrollee will be at the center of the care planning process. Reflect the Enrollee’s preferences and needs. The Contractor will ensure that the Enrollee receives any necessary assistance and accommodations to prepare for and fully participate in the care planning process, including the development of the ICP, and that the Enrollee receives clear information about: His/her health status, including functional limitations; How family members and social supports can be involved in the care planning as the Enrollee chooses; Self‑directed care options and assistance available to self‑direct care; Opportunities for educational and vocational activities; and Available treatment options, supports and/or alternative courses of care. Specify how services and care will be integrated and coordinated among health care providers, and community and social services providers where relevant to the Enrollee’s care; Include, but is not limited to: A summary of the Enrollee’s health history; A prioritized list of concerns, goals and strengths; The plan for addressing concerns or goals; The person(s) responsible for specific interventions; and The due date for each intervention. The Contractor must establish and execute policies and procedures that provide mechanisms by which an Enrollee can sign or otherwise convey approval of his or her ICP when it is developed and at the time of subsequent modifications to it. The Contractor must: Inform an Enrollee of his or her right to approve the ICP; Provide mechanisms for an Enrollee to sign or otherwise convey approval of the ICP that meet his or her accessibility needs; Inform an Enrollee of his or her right to an Appeal of any denial, termination, suspension, or reduction in services, or any other change in providers, services, or medications, included in the ICP; Provide the Enrollee with access to their ICP; Inform an Enrollee how to submit a Grievance or an Appeal; and Inform an Enrollee how to contact the Ombudsman. Service Requests The Contractor must: Accept at any time from an Enrollee a Service Request or other request for a modification of the ICP. Document all Service Requests and other requests for a modification of the ICP in the Enrollee’s Centralized Enrollee Record. Educate Enrollees about the process and timetable for Service Requests, including but not limited to how long a member will need to wait before a decision is rendered: During the initial welcome call, and Before the annual review of the ICP.

MDS-HC Assessment. The Contractor must complete MDS‑HC MDS-HC assessments for its Enrollees as described below. The MDS‑HC MDS-HC must be completed in‑person in-person by a registered nurse. Information collected on the MDS‑HC MDS-HC must be sent to MassHealth via the MDS‑HC MDS-HC application in the Commonwealth’s Virtual Gateway to ensure accurate assignment of Rating Categories. The Contractor must cooperate with and participate in any and all requests made by MassHealth for further information concerning any MDS‑HC MDS-HC submission. The MDS‑HC MDS-HC must be completed as follows: For Enrollees assigned to the C1 Rating Category, the MDS‑HC MDS-HC must be completed to change the Rating Category; For Enrollees assigned to the C2 Rating Categories, including C2A and C2B, the MDS‑HC MDS-HC must be completed within 90 days 6 months of the Enrollee’s Effective Enrollment Date into One Care, and at least annually thereafter; For Enrollees assigned to the C3 Rating Categories, including C3A and amd C3B, the MDS‑HC MDS-HC must be completed within 90 days of the Enrollee’s Effective Enrollment Date into One Care and at least annually thereafter; For Enrollees assigned to the C4 C3 Rating CategoryCategory C3C, the MDS‑HC MDS-HC must be completed: Within thirty (30) days following the Enrollee’s admission into a Transitional Living Program; and Prior to the end of the month of discharge from a Transitional Living Program; In order to change any Enrollee’s Rating Category to a Rating Category, other than the F1 Rating Category based on the Enrollee’s current residence in a long‑term long-term care facility for at least ninety (90) days. Individualized Care Plan The Contractor shall: Engage each Enrollee in ongoing development of their ICP. Ensure that the ICT integrates and coordinates services, including, but not limited to engaging each Enrollee in the development of an ICP. The ICP must: Incorporate the results of the Comprehensive Assessment and specify any changes in providers, services, or medications. Be developed by the ICT under the direction of the Enrollee (and/or the Enrollee’s representative, if applicable), and in consultation with any specialists caring for the Enrollee, in accordance with 42 C.F.R. 438.208(c)(3) and 42 C.F.R. 422.112(a)(6)(iii) and updated periodically to reflect changing needs identified in Comprehensive Assessments. The Enrollee will be at the center of the care planning process. Reflect the Enrollee’s preferences and needs. The Contractor will ensure that the Enrollee receives any necessary assistance and accommodations to prepare for and fully participate in the care planning process, including the development of the ICP, and that the Enrollee receives clear information about: His/her health status, including functional limitations; How family members and social supports can be involved in the care planning as the Enrollee chooses; Self‑directed Self-directed care options and assistance available to self‑direct self-direct care; Opportunities for educational and vocational activities; and Available treatment options, supports and/or alternative courses of care. Specify how services and care will be integrated and coordinated among health care providers, and community and social services providers where relevant to the Enrollee’s care; Include, but is not limited to: A summary of the Enrollee’s health history; A prioritized list of concerns, goals and strengths; The plan for addressing concerns or goals; The person(s) responsible for specific interventions; and The due date for each intervention. The Contractor must establish and execute policies and procedures that provide mechanisms by which an Enrollee can sign or otherwise convey approval of his or her ICP when it is developed and at the time of subsequent modifications to it. The Contractor must: Inform an Enrollee of his or her right to approve the ICP; Provide mechanisms for an Enrollee to sign or otherwise convey approval of the ICP that meet his or her accessibility needs; Inform an Enrollee of his or her right to an Appeal of any denial, termination, suspension, or reduction in services, or any other change in providers, services, or medications, included in the ICP; Provide the Enrollee with access to their ICP; Inform an Enrollee how to submit a Grievance or an Appeal; and Inform an Enrollee how to contact the Ombudsman. Service Requests The Contractor must: Accept at any time from an Enrollee a Service Request or other request for a modification of the ICP. Document all Service Requests and other requests for a modification of the ICP in the Enrollee’s Centralized Enrollee Record. Educate Enrollees about the process and timetable for Service Requests, including but not limited to how long a member will need to wait before a decision is rendered: During the initial welcome call, and Before the annual review of the ICP.

MDS-HC Assessment. The Contractor must complete MDS‑HC assessments for its Enrollees as described below. The MDS‑HC must be completed in‑person by a registered nurse. Information collected on the MDS‑HC must be sent to MassHealth via the MDS‑HC application in the Commonwealth’s Virtual Gateway to ensure accurate assignment of Rating Categories. The Contractor must cooperate with and participate in any and all requests made by MassHealth for further information concerning any MDS‑HC submission. The MDS‑HC must be completed as follows: For Enrollees assigned to the C1 Rating Category, the MDS‑HC must be completed to change the Rating Category; For Enrollees assigned to the C2 Rating Categories, including C2A and C2B, the MDS‑HC must be completed within 90 days 6 months of the Enrollee’s Effective Enrollment Date into One Care, and at least annually thereafter; For Enrollees assigned to the C3 Rating Categories, including C3A and C3B, the MDS‑HC must be completed within 90 days of the Enrollee’s Effective Enrollment Date into One Care and at least annually thereafter; For Enrollees assigned to the C4 C3 Rating CategoryCategory C3C, the MDS‑HC must be completed: Within thirty (30) days following the Enrollee’s admission into a Transitional Living Program; and Prior to the end of the month of discharge from a Transitional Living Program; In order to change any Enrollee’s Rating Category to a Rating Category, other than the F1 Rating Category based on the Enrollee’s current residence in a long‑term care facility for at least ninety (90) days. The Contractor shall: Engage each Enrollee in ongoing development of their ICP. Ensure that the ICT integrates and coordinates services, including, but not limited to engaging each Enrollee in the development of an ICP. The ICP must: Incorporate the results of the Comprehensive Assessment and specify any changes in providers, services, or medications. Be developed by the ICT under the direction of the Enrollee (and/or the Enrollee’s representative, if applicable), and in consultation with any specialists caring for the Enrollee, in accordance with 42 C.F.R. 438.208(c)(3) and 42 C.F.R. 422.112(a)(6)(iii) and updated periodically to reflect changing needs identified in Comprehensive Assessments. The Enrollee will be at the center of the care planning process. Reflect the Enrollee’s preferences and needs. The Contractor will ensure that the Enrollee receives any necessary assistance and accommodations to prepare for and fully participate in the care planning process, including the development of the ICP, and that the Enrollee receives clear information about: His/her health status, including functional limitations; How family members and social supports can be involved in the care planning as the Enrollee chooses; Self‑directed care options and assistance available to self‑direct care; Opportunities for educational and vocational activities; and Available treatment options, supports and/or alternative courses of care. Specify how services and care will be integrated and coordinated among health care providers, and community and social services providers where relevant to the Enrollee’s care; Include, but is not limited to: A summary of the Enrollee’s health history; A prioritized list of concerns, goals and strengths; The plan for addressing concerns or goals; The person(s) responsible for specific interventions; and The due date for each intervention. The Contractor must establish and execute policies and procedures that provide mechanisms by which an Enrollee can sign or otherwise convey approval of his or her ICP when it is developed and at the time of subsequent modifications to it. The Contractor must: Inform an Enrollee of his or her right to approve the ICP; Provide mechanisms for an Enrollee to sign or otherwise convey approval of the ICP that meet his or her accessibility needs; Inform an Enrollee of his or her right to an Appeal of any denial, termination, suspension, or reduction in services, or any other change in providers, services, or medications, included in the ICP; Provide the Enrollee with access to their ICP; Inform an Enrollee how to submit a Grievance or an Appeal; and Inform an Enrollee how to contact the Ombudsman. Service Requests The Contractor must: Accept at any time from an Enrollee a Service Request or other request for a modification of the ICP. Document all Service Requests and other requests for a modification of the ICP in the Enrollee’s Centralized Enrollee Record. Educate Enrollees about the process and timetable for Service Requests, including but not limited to how long a member will need to wait before a decision is rendered: During the initial welcome call, and Before the annual review of the ICP.