Common use of Member Participation Clause in Contracts

Member Participation. The MCO is required to ensure that each member has a meaningful opportunity to participate in the initial development of, and updating of, 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. Members shall receive clear explanations of: The member’s health conditions and functional limitations; Available treatment options, supports and/or alternative courses of care; The member’s role as part of the interdisciplinary care team; The full range of residential options, including in-home care, residential care and nursing home care when applicable; The benefits, drawbacks and likelihood of success of each option; Risks involved in specific member preferences; The possible consequences of refusal to follow the recommended course of care; and The member’s available choices regarding the services and supports he/she receives and from whom. 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. Interdisciplinary Team Composition‌ 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: Assure that every member’s IDT has some level of participation by a nurse practitioner; Establish procedures for identifying the most appropriate level of participation by a nurse practitioner with the IDT of each individual member by taking into account the unique conditions and circumstances of the member; and Assure that nurse practitioners are readily available to members who have the most need for advanced practice health care. On a case-by-case basis, the MCO may choose to use a physician assistant or advanced practice nurse prescriber with experience working with the target groups and with demonstrated capacity to work independently to fulfill the need for advanced practice health care. The MCO will continue to ensure each member has access to an appropriate level of advanced practice health care. Assessment and Member-Centered Planning Process‌ Member-centered planning is an ongoing process and the member-centered plan (MCP) is a dynamic document that must reflect significant changes experienced in members’ lives. Information is captured through the initial comprehensive assessment and changes are reflected through ongoing re-assessments. Member-centered planning reflects understanding between the member and the IDT staff and will demonstrate changes that occur with the member’s outcomes and health status. The member is always central to the member-centered planning and comprehensive assessment process. The IDT staff will ensure that the member is at the center of the member-centered planning process. The member will actively participate in the planning process, in particular, in the identification of personal outcomes and preferences. All aspects of the member-centered planning and comprehensive assessment process involving the participation of the member must be timely and occur at times and locations consistent with the requirements of Article V.C and H. The member-centered plan incorporates the following processes: Comprehensive Assessment Purpose

Member Participation. The MCO is required to ensure that each member has a meaningful opportunity to participate in the initial development of, and updating of, the member’s 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 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. Members shall receive clear explanations of: The member’s His/her health conditions and functional limitations; Available treatment options, supports and/or alternative courses of care; The member’s role as part of the interdisciplinary care team; The full range of residential options, including in-home care, residential care and nursing home care when applicable; The benefits, drawbacks and likelihood of success of each option; Risks involved in specific member preferences; The possible consequences of refusal to follow the recommended course of care; and The member’s His/her available choices regarding the services and supports he/she receives and from whom. 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. Interdisciplinary Team Composition‌ Composition 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; For PACE, a Master’s level social worker, a Wisconsin licensed registered nurse, a Wisconsin licensed nurse practitioner and a primary care physician and other professional disciplines as defined in 42 C.F.R. § 460.102. 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 a social worker certified in Wisconsin with or have 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 other area other than human services with a minimum of three (3) years’ experience working in social service care management or related social service experience with persons in the MCO’s target population. Individuals holding a position comparable to a social service coordinator at least one the time an MCO first contracts to deliver a managed long-term care program in a new service area or to a new target population may be exempted from this requirement at the discretion of the Family Care target populationsDepartment. 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: Assure that every member’s IDT has some level of participation by a nurse practitioner; Establish procedures for identifying the most appropriate level of participation by a nurse practitioner with the IDT of each individual member by taking into account the unique conditions and circumstances of the member; and Assure that nurse practitioners are readily available to members who have the most need for advanced practice health care. On a case-by-case basis, the MCO may choose to use a physician assistant or advanced practice nurse prescriber with experience working with the target groups and with demonstrated capacity to work independently to fulfill the need for advanced practice health care. The MCO will continue to ensure each member has access to an appropriate level of advanced practice health care. Assessment and Member-Centered Planning Process‌ Member-centered planning is an ongoing process and the member-centered plan (MCP) is a dynamic document that must reflect significant changes experienced in members’ lives. Information is captured through the initial comprehensive assessment and changes are reflected through ongoing re-assessments. Member-centered planning reflects understanding between the member and the IDT staff and will demonstrate changes that occur with the member’s outcomes and health status. The member is always central to the member-centered planning and comprehensive assessment process. The IDT staff will ensure that the member is at the center of the member-centered planning process. The member will actively participate in the planning process, in particular, in the identification of personal outcomes and preferences. All aspects of the member-centered planning and comprehensive assessment process involving the participation of the member must be timely and occur at times and locations consistent with the requirements of Article V.C and H. The member-centered plan incorporates the following processes: Comprehensive Assessment Purpose.

Member Participation. The MCO is required to ensure that each member has a meaningful opportunity to participate in the initial development of, and updating of, the member’s 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 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 he/she would like to invite a representative from the member’s his/her 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. Members shall receive clear explanations of: The member’s His/her health conditions and functional limitations; Available treatment options, supports and/or alternative courses of care; The member’s role as part of the interdisciplinary care team; The full range of residential options, including in-home care, residential care and nursing home care when applicable; The benefits, drawbacks and likelihood of success of each option; Risks involved in specific member preferences; The possible consequences of refusal to follow the recommended course of care; and The member’s His/her available choices regarding the services and supports he/she receives and from whom. 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. Interdisciplinary Team Composition‌ Composition 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: Assure that every member’s IDT has some level of participation by a nurse practitioner; Establish procedures for identifying the most appropriate level of participation by a nurse practitioner with the IDT of each individual member by taking into account the unique conditions and circumstances of the member; and Assure that nurse practitioners are readily available to members who have the most need for advanced practice health care. On a case-by-case basis, the MCO may choose to use a physician assistant or advanced practice nurse prescriber with experience working with the target groups and with demonstrated capacity to work independently to fulfill the need for advanced practice health care. The MCO will continue to ensure each member has access to an appropriate level of advanced practice health care. Assessment and Member-Centered Planning Process‌ Process Member-centered planning is an ongoing process and the member-centered plan (MCP) is a dynamic document that must reflect significant changes experienced in members’ lives. Information is captured through the initial comprehensive assessment and changes are reflected through ongoing re-assessments. Member-centered planning reflects understanding between the member and the IDT staff and will demonstrate changes that occur with the member’s outcomes and health status. The member is always central to the member-member centered planning and comprehensive assessment process. The IDT staff will ensure that the member is at the center of the member-member centered planning process. The member will actively participate in the planning process, in particular, in the identification of personal outcomes and preferences. All aspects of the member-member centered planning and comprehensive assessment process involving the participation of the member must be timely and occur at times and locations consistent with the requirements of Article V.C and H. The member-member centered plan incorporates the following processes: Comprehensive Assessment Purpose

Member Participation. The MCO is required to ensure that each member has a meaningful opportunity to participate in the initial development of, and updating of, the member’s 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 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. Members shall receive clear explanations of: The member’s His/her health conditions and functional limitations; Available treatment options, supports and/or alternative courses of care; The member’s role as part of the interdisciplinary care team; The full range of residential options, including in-home care, residential care and nursing home care when applicable; The benefits, drawbacks and likelihood of success of each option; Risks involved in specific member preferences; The possible consequences of refusal to follow the recommended course of care; and The member’s His/her available choices regarding the services and supports he/she receives and from whom. 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. Interdisciplinary Team Composition‌ Composition 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: Assure that every member’s IDT has some level of participation by a nurse practitioner; Establish procedures for identifying the most appropriate level of participation by a nurse practitioner with the IDT of each individual member by taking into account the unique conditions and circumstances of the member; and Assure that nurse practitioners are readily available to members who have the most need for advanced practice health care. On a case-by-case basis, the MCO may choose to use a physician assistant or advanced practice nurse prescriber with experience working with the target groups and with demonstrated capacity to work independently to fulfill the need for advanced practice health care. The MCO will continue to ensure each member has access to an appropriate level of advanced practice health care. Assessment and Member-Centered Planning Process‌ Process Member-centered planning is an ongoing process and the member-centered plan (MCP) is a dynamic document that must reflect significant changes experienced in members’ lives. Information is captured through the initial comprehensive assessment and changes are reflected through ongoing re-assessments. Member-centered planning reflects understanding between the member and the IDT staff and will demonstrate changes that occur with the member’s outcomes and health status. The member is always central to the member-member centered planning and comprehensive assessment process. The IDT staff will ensure that the member is at the center of the member-member centered planning process. The member will actively participate in the planning process, in particular, in the identification of personal outcomes and preferences. All aspects of the member-member centered planning and comprehensive assessment process involving the participation of the member must be timely and occur at times and locations consistent with the requirements of Article V.C and H. The member-member centered plan incorporates the following processes: Comprehensive Assessment Purpose

Member Participation. The MCO IHCP is required to ensure that each member has a meaningful opportunity to participate in the initial development of, and updating of, the member’s his/her member- centered plan (MCP). The MCO IHCP 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 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- 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 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. Members shall receive clear explanations of: The member’s His/her health conditions and functional limitations; Available treatment options, supports and/or alternative courses of care; The member’s role as part of the interdisciplinary care team; The full range of residential options, including in-home care, residential care and nursing home care when applicable; The benefits, drawbacks and likelihood of success of each option; Risks involved in specific member preferences; The possible consequences of refusal to follow the recommended course of care; and The member’s His/her available choices regarding the services and supports he/she receives and from whom. 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. Interdisciplinary Team Composition‌ Composition 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, licensed registered nurse and any other staff who are assigned or contracted by the MCO IHCP 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 must 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 's experience working with at least one of the Family Care target populations; or . An individual with a four-four year bachelor’s 's degree or more advanced degree in the human services area and a minimum of one (1) year’s 's experience working with at least one of the Family Care target populations; or . An individual with a four-four year bachelor’s 's degree or more advanced degree in any area other than human services with a minimum of three (3) years’ 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 Family Care program 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 MCOFamily Care program, and of the individual members to whom they are assigned. The MCO IHCP 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: Assure that every member’s IDT has some level of participation by a nurse practitioner; Establish procedures for identifying the most appropriate level of participation by a nurse practitioner with the IDT of each individual member by taking into account the unique conditions and circumstances of the member; and Assure that nurse practitioners are readily available to members who have the most need for advanced practice health care. On a case-by-case basis, the MCO may choose to use a physician assistant or advanced practice nurse prescriber with experience working with the target groups and with demonstrated capacity to work independently to fulfill the need for advanced practice health care. The MCO will continue to ensure each member has access to an appropriate level of advanced practice health care. Assessment and Member-Centered Planning Process‌ Process Member-centered planning is an ongoing process and the member-centered plan (MCP) is a dynamic document that must reflect significant changes experienced in members’ lives. Information is captured through the initial comprehensive assessment and changes are reflected through ongoing re-assessments. Member-centered planning reflects understanding between the member and the IDT staff and will demonstrate changes that occur with the member’s outcomes and health status. The member is always central to the member-member centered planning and comprehensive assessment process. The IDT staff will ensure that the member is at the center of the member-member centered planning process. The member will actively participate in the planning process, in particular, in the identification of personal outcomes and preferences. All aspects of the member-member centered planning and comprehensive assessment process involving the participation of the member must be timely and occur at times and locations consistent with the requirements of Article V.C IV.D. and H. The member-member centered plan incorporates the following processes: Comprehensive Assessment Purpose

Member Participation. The MCO is required to ensure that each member has a meaningful opportunity to participate in the initial development of, and updating of, 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. Members shall receive clear explanations of: The member’s health conditions and functional limitations; Available treatment options, supports and/or alternative courses of care; The member’s role as part of the interdisciplinary care team; The full range of residential options, including in-home care, residential care and nursing home care when applicable; The benefits, drawbacks and likelihood of success of each option; Risks involved in specific member preferences; The possible consequences of refusal to follow the recommended course of care; and The member’s available choices regarding the services and supports he/she the member receives and from whom. 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. Interdisciplinary Team Composition‌ Composition 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: Assure that every member’s IDT has some level of participation by a nurse practitioner; Establish procedures for identifying the most appropriate level of participation by a nurse practitioner with the IDT of each individual member by taking into account the unique conditions and circumstances of the member; and Assure that nurse practitioners are readily available to members who have the most need for advanced practice health care. On a case-by-case basis, the MCO may choose to use a physician assistant or advanced practice nurse prescriber with experience working with the target groups and with demonstrated capacity to work independently to fulfill the need for advanced practice health care. The MCO will continue to ensure each member has access to an appropriate level of advanced practice health care. Assessment and Member-Centered Planning Process‌ Member-centered planning is an ongoing process and the member-centered plan (MCP) is a dynamic document that must reflect significant changes experienced in members’ lives. Information is captured through the initial comprehensive assessment and changes are reflected through ongoing re-assessments. Member-centered planning reflects understanding between the member and the IDT staff and will demonstrate changes that occur with the member’s outcomes and health status. The member is always central to the member-centered planning and comprehensive assessment process. The IDT staff will ensure that the member is at the center of the member-centered planning process. The member will actively participate in the planning process, in particular, in the identification of personal outcomes and preferences. All aspects of the member-centered planning and comprehensive assessment process involving the participation of the member must be timely and occur at times and locations consistent with the requirements of Article V.C and H. The member-centered plan incorporates the following processes: Comprehensive Assessment Purpose: