Member Participation. 1. The MCO is required to ensure that each member has a meaningful opportunity to participate in the initial development of, and updating of, his/her member- centered plan (MCP). The MCO is required to encourage members to take an active role in decision-making regarding the long-term care and health care services they need to live as independently as possible. The MCO is expected to ensure that the member, the member’s legal decision maker and any other persons identified by the member will be included in the care management processes of assessment, member outcomes identification, member- centered plan development, and reassessment. This process must reflect cultural considerations of the individual and must be conducted by providing information in plain language and in a manner that is accessible to individuals with disabilities through the provision of auxiliary aids and services at no cost to the individual and for persons who are limited English proficient through the provision of language services at no cost to the member. The MCO shall provide information, education and other reasonable support as requested and needed by members, other persons identified by the member or legal decision makers in order to make informed long-term care and health care service decisions. 2. Members shall receive clear explanations of: a. His/her health conditions and functional limitations; b. Available treatment options, supports and/or alternative courses of care; c. The member’s role as part of the interdisciplinary care team; d. The full range of residential options, including in-home care, residential care and nursing home care when applicable; e. The benefits, drawbacks and likelihood of success of each option; f. Risks involved in specific member preferences; g. The possible consequences of refusal to follow the recommended course of care; and h. His/her available choices regarding the services and supports he/she receives and from whom. 3. The MCO shall inform members of specific conditions that require follow-up, and if appropriate, provide training and education in self-care. If there are factors that hinder full participation with recommended treatments or interventions, then these factors will be identified and explained in the member-centered planning process.
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Member Participation. 1. The MCO is required to ensure that each member has a meaningful opportunity to participate in the initial development of, and updating of, his/her member- centered plan (MCP). The MCO is required to encourage members to take an active role in decision-making regarding the long-term care and health care services they need to live as independently as possible. The MCO is expected to ensure that the member, the member’s legal decision maker authorized representative and any other persons identified by the member will be included in the care management processes of assessment, member outcomes identification, member- member-centered plan development, and reassessment. This process must reflect cultural considerations of the individual and must be conducted by providing information in plain language and in a manner that is accessible to individuals with disabilities through the provision of auxiliary aids and services at no cost to the individual and for persons who are limited English proficient through the provision of language services at no cost to the member. The MCO shall provide information, education and other reasonable support as requested and needed by members, other persons identified by the member members’ families or legal decision makers authorized representatives in order to make informed long-term care and health care service decisions.
2. Members shall receive clear explanations of:
a. His/her health conditions and functional limitations;
b. Available treatment options, supports and/or alternative courses of care;
c. The member’s role as part of the interdisciplinary care team;
d. The full range of residential options, including in-home care, residential care and nursing home care when applicable;
e. The benefits, drawbacks and likelihood of success of each option;
f. Risks involved in specific member preferences;
g. The possible consequences of refusal to follow the recommended course of care; and
h. His/her available choices regarding the services and supports he/she receives and from whom.
3. The MCO shall inform members of specific conditions that require follow-up, and if appropriate, provide training and education in self-care. If there are factors that hinder full participation with recommended treatments or interventions, then these factors will be identified and explained in the member-centered planning process.
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Samples: Contract, <<program>> Contract
Member Participation. 1. The MCO is required to ensure that each member has a meaningful opportunity to participate in the initial development of, and updating of, his/her member- centered plan (MCP). The MCO is required to encourage members to take an active role in decision-making regarding the long-term care and health care services they need to live as independently as possible. The MCO is expected to ensure that the member, the member’s legal decision maker and any other persons identified by the member will be included in the care management processes of assessment, member outcomes identification, member- centered plan development, and reassessment. This process must reflect cultural considerations of the individual and must be conducted by providing information in plain language and in a manner that is accessible to individuals with disabilities through the provision of auxiliary aids and services at no cost to the individual and for persons who are limited English proficient through the provision of language services at no cost to the member. The MCO shall provide information, education and other reasonable support as requested and needed by members, other persons identified by the member or legal decision makers in order to make informed long-term care and health care service decisions.
2. Members shall receive clear explanations of:
a. His/her health conditions and functional limitations;
b. Available treatment options, supports and/or alternative courses of care;
c. The member’s role as part of the interdisciplinary care team;
d. The full range of residential options, including in-home care, residential care and nursing home care when applicable;
e. The benefits, drawbacks and likelihood of success of each option;
f. Risks involved in specific member preferences;
g. The possible consequences of refusal to follow the recommended course of care; and
h. His/her available choices regarding the services and supports he/she receives and from whom.
3. The MCO shall inform members of specific conditions that require follow-up, and if appropriate, provide training and education in self-care. If there are factors that hinder full participation with recommended treatments or interventions, then these factors will be identified and explained in the member-centered planning process.
Appears in 2 contracts
Member Participation.
1. The MCO IHCP is required to ensure that each member has a meaningful opportunity to participate in the initial development of, and updating of, his/her member- member-centered plan (MCP). The MCO IHCP is required to encourage members to take an active role in decision-decision- making regarding the long-term care and health care services they need to live as independently as possible. The MCO IHCP is expected to ensure that the member, the member’s legal decision maker and any other persons identified by the member will be included in the care management processes of assessment, member outcomes identification, member- member-centered plan development, and reassessment. This process must reflect cultural considerations of the individual and must be conducted by providing information in plain language and in a manner that is accessible to individuals with disabilities through the provision of auxiliary aids and services at no cost to the individual and for persons who are limited English proficient through the provision of language services at no cost to the member. The MCO IHCP shall provide information, education and other reasonable support as requested and needed by members, other persons identified by the member or legal decision makers in order to make informed long-term care and health care service decisions.
2. Members shall receive clear explanations of:
a. His/her health conditions and functional limitations;
b. Available treatment options, supports and/or alternative courses of care;
c. The member’s role as part of the interdisciplinary care team;
d. The full range of residential options, including in-home care, residential care and nursing home care when applicable;
e. The benefits, drawbacks and likelihood of success of each option;
f. Risks involved in specific member preferences;
g. The possible consequences of refusal to follow the recommended course of care; and
h. His/her available choices regarding the services and supports he/she receives and from whom.
3. The MCO IHCP shall inform members of specific conditions that require follow-up, and if appropriate, provide training and education in self-care. If there are factors that hinder full participation with recommended treatments or interventions, then these factors will be identified and explained in the member-centered planning process.
Appears in 1 contract
Samples: Family Care Agreement
Member Participation. 1. The MCO is required to ensure that each member has a meaningful opportunity to participate in the initial development of, and updating of, his/her the member’s member- centered plan (MCP). The MCO is required to encourage members to take an active role in decision-making regarding the long-term care and health care services they need to live as independently as possible. The MCO is expected to ensure that the member, the member’s legal decision maker and any other persons identified by the member will be included in the care management processes of assessment, member outcomes identification, member- centered plan development, and reassessment. This process must reflect cultural and other identity considerations of the individual and must be conducted by providing information in plain language and in a manner that is accessible to individuals with disabilities through the provision of auxiliary aids and services as needed, at no cost to the individual and for persons who are limited English proficient through the provision of language services at no cost to the member. If the member’s enrollment form indicates the member is an American Indian/Alaskan Native, the MCO must ask the member if the member would like to invite a representative from the member’s tribe to participate in the care management process. The MCO shall provide information, education and other reasonable support as requested and needed by members, other persons identified by the member or legal decision makers in order to make informed long-term care and health care service decisions.
2. Members shall receive clear explanations of:
a. His/her : The member’s health conditions and functional limitations;
b. ; Available treatment options, supports and/or alternative courses of care;
c. ; The member’s role as part of the interdisciplinary care team;
d. ; The full range of residential options, including in-home care, residential care and nursing home care when applicable;
e. ; The benefits, drawbacks and likelihood of success of each option;
f. ; Risks involved in specific member preferences;
g. ; The possible consequences of refusal to follow the recommended course of care; and
h. His/her and The member’s available choices regarding the services and supports he/she the member receives and from whom.
3. The MCO shall inform members of specific conditions that require follow-up, and if appropriate, provide training and education in self-care. If there are factors that hinder full participation with recommended treatments or interventions, then these factors will be identified and explained in the member-centered planning process.. The interdisciplinary team (IDT) is the vehicle for providing member-centered care management. The full IDT always includes the member and other people specified by the member, as well as IDT staff. Throughout this article the term “IDT staff” refers to the social service coordinator, registered nurse and any other staff who are assigned or contracted by the MCO to participate in the IDT and is meant to distinguish those staff from the full IDT. The member receives care management through designated IDT staff, which at a minimum include the following: For Family Care, a social service coordinator and a Wisconsin licensed registered nurse; For Partnership, a social service coordinator, a Wisconsin licensed registered nurse and a Wisconsin licensed nurse practitioner. The team may include additional persons with specialized expertise for assessment, consultation, ongoing coordination efforts and other assistance as needed. A “social service coordinator” is required to be one of the following: A social worker certified in Wisconsin with a minimum of one (1) year’s experience working with at least one of the Family Care target populations; or An individual with a four-year bachelor’s degree or more advanced degree in the human services area and a minimum of one (1) year’s experience working with at least one of the Family Care target populations; or An individual with a four-year bachelor’s degree or more advanced degree in any area other than human services with a minimum of three (3) years’ experience working with at least one of the Family Care target populations. The IDT staff shall have knowledge of community alternatives for the target populations served by the MCO and the full range of long-term care resources. IDT staff shall also have specialized knowledge of the conditions and functional limitations of the target populations served by the MCO, and of the individual members to whom they are assigned. The MCO shall establish a means that ensures ease of access and a reasonable level of responsiveness for each member to their IDT staff during regular business hours. The Department recognizes that in the Partnership Program an MCO may encounter a shortage of available nurse practitioners. In order to make best use of the time of nurse practitioners while still assuring Partnership members have access to a nurse practitioner, an MCO may develop policies and procedures to apportion, in a way that is responsive to individual member needs, the time nurse practitioners work with the IDT of each individual member. Such policies and procedures may be guided by the needs of the population and could, under some circumstances use the time of a nurse practitioner solely to access prescriptions, provide triage services and as an educational resource for the IDT staff. All such policies and procedures will:
Appears in 1 contract
Samples: Contract
