Plan of Care. The Care Manager will authorize and coordinate the provision of Covered Services rendered under this Agreement and as may be referenced in the Provider Handbook. Provider shall adhere to the Plan of Care established for Enrollees. Except in the case where a Enrollee's health or safety is in jeopardy, where such transfer to another Provider may be immediate, Provider shall refer and cooperate with the transfer of Enrollees for Covered Services only to Providers designated, specifically approved or under contract with ILS Community Network and Managed Care Plan. The Provider, in the event of a transitioning Enrollee, including in the event of the termination of this Agreement, shall cooperate in all respects with Providers of other Managed Care Plans to assure maximum health outcomes for Enrollees. In the event that Provider renders a Enrollee non-covered services or refers a Enrollee to an out-of-network provider without pre-authorization from ILS Community Network or Managed Care Plan, Provider shall prior to the provision of such non-covered services or such out-of- network referral, inform the Enrollee in writing: (1) of the services to be provided or referral to be made; (2) that ILS Community Network and Managed Care Plan will not pay (or may pay a reduced benefit in the case of ILS Community Network and Managed Care Plan's point of service (POS) and/or preferred provider organization (PPO) products) or be liable financially for such non-covered service or out-of network referral and (3) that Enrollee will be responsible financially for non-covered service(s) and/or out-of-network referral(s) that are requested by the Enrollee. Provider acknowledges and agrees that the failure to inform Xxxxxxxx(s) in accordance with this paragraph may result in financial liability to Provider for the cost of such non-covered or non-authorized service(s). The Provisions of this Section shall not prohibit a Enrollee from receiving inpatient services in a contracted hospital if such services are determined by the Managed Care Plan to be medically necessary Covered Services. This Agreement shall not prohibit a Provider from discussing treatment or non-treatment options with Enrollees that may not reflect the Managed Care Plan's position or may not be covered by the Managed Care Plan; and shall not prohibit a Provider from acting within the lawful scope of practice, from advising or advocating on behalf of a Enrollee for the Enrollee's health status, medical care, or treat...
Plan of Care. A plan which describes the service needs of each enrollee, showing the projected duration, desired frequency, type of provider furnishing each service, and scope of the services to be provided.
Plan of Care. The Health Plan shall perform a needs assessment and develop a plan of care for each enrollee. The Health Plan shall base the plan of care on a comprehensive assessment of the enrollee's health status, physical and cognitive functioning, environment, and social supports. The Health Plan shall not impose service limitations based solely on the enrollees’ place of residence. The plan of care must detail all interventions designed to address specific barriers to independent functioning. The Health Plan shall clearly identify barriers to the enrollee and caregivers, if applicable. The case manager must discuss barriers and explore potential solutions with the enrollee and caregivers when applicable. In developing the plan of care the Health Plan shall:
(1) Assess the immediacy of the new enrollee’s services needs and include a description of the enrollee’s condition (e.g., Activities of Daily Living (ADL), and Instrumental Activities of Daily Living limitations (IADL), incontinence, cognitive impairment, arthritis, high blood pressure), as identified through an appropriate comprehensive assessment and a medical history review;
(2) Identify any existing care plans and service providers and assess the adequacy of current services;
(3) Ensure that the plan of care contains, at a minimum, information about the enrollee’s medical condition, the types of services to be furnished, the amount, frequency and duration of each service, and the type of provider to furnish each service;
(4) Ensure that treatment interventions address identified problems, needs and conditions in consultation with the enrollee and, as appropriate, the enrollee’s legal guardian or caregiver;
(5) Ensure that, at minimum, the Health Plan conducts a quarterly review of the enrollee’s plan of care to determine the appropriateness and adequacy of services, and to ensure that the services furnished are consistent with the nature and severity of needs. Documentation of this quarterly review shall be maintained on file and provided at the Agency’s request;
(6) Ensure that a face-to-face review of the plan of care is performed through contact with the enrollee at least every six (6) months to determine the appropriateness and adequacy of services and to ensure that the services furnished are consistent with the nature and severity of the enrollee’s needs; An Agency-approved form signed by the enrollee at the time of the review shall be maintained on file and provided at the Agency’s request;
(7) Ensur...
Plan of Care. 20.6.1 As specified in BHIN 22-019, when a plan of care is required, Contractor shall follow the DHCS requirements outlined in the Alcohol and/or Other Drug Program Certification Standards document, available in the DHCS Facility Certification page at: xxxxx://xxx.xxxx.xx.xxx/provgovpart/Pages/Licensing- and-Certification-Facility-Certification.aspx
20.6.2 Contractor is not required to complete a plan of care for clients under this Agreement, except in the below circumstances:
20.6.2.1 Peer Support Services require a specific care plan based on an approved Plan of Care. The plan of care shall be documented within the progress notes in the client’s clinical record and approved by any treating provider who can render reimbursable Medi-Cal services.
20.6.2.2 Narcotic Treatment Programs (NTP) are required to create a plan of care for clients as per federal law. This requirement is not impacted by the documentation requirements in BHIN 22-019. NTPs shall continue to comply with federal and state regulations regarding plans of care and documentation requirements.
Plan of Care. 22.1. As specified in BHIN 22-019, when a plan of care is required, CONTRACTOR shall follow the DHCS requirements outlined in the Alcohol and/or Other Drug Program Certification Standards document, available in the DHCS Facility Certification page at: xxxxx://xxx.xxxx.xx.xxx/provgovpart/Pages/Licensing-and-Certification-Facility- Certification.aspx
22.2. CONTRACTOR shall develop plans of care for all clients, when required, and these plans of care shall include the following:
22.2.1. Statement of problems experienced by the client to be addressed.
22.2.2. Statement of objectives to be reached that address each problem.
22.2.3. Statement of actions that will be taken by the program and/or client to accomplish the identified objectives.
22.2.4. Target date(s) for accomplishment of actions and objectives.
22.3. CONTRACTOR shall develop the plan of care with participation from the client in accordance with the timeframes specified below:
22.3.1. For outpatient programs, the plan of care shall be developed within 30 calendar days from the date of the client’s admission. The client’s progress shall be reviewed and documented within 30 calendar days after signing the plan of care and not later than every 30 calendar days thereafter.
22.3.2. For residential programs, the plan of care shall be developed within 10 calendar days from the date of the client’s admission.
22.3.3. An LPHA, registered or certified counselor shall ensure and document, that together with the client, the plan of care is reviewed and updated, as necessary, when a change in problem identification or focus of treatment occurs, or no later than 90 calendar days after signing the plan of care and no later than every 90 calendar days thereafter, whichever comes first.
22.4. CONTRACTOR is not required to complete a plan of care for clients under this Agreement, except in the below circumstances:
Plan of Care. All Qualified Long-Term Care Services for which You claim benefits must be prescribed in a written Plan of Care prepared by a Licensed Health Care Practitioner who is an employee of the Care Coordination Provider Agency or an Official Designee of the Care Coordination Provider Agency.
Plan of Care. The Plan of Care is a written plan developed in collaboration with the member, the member’s family (with written consent), guardian or adult caretaker, PCP and other providers involved with the member to delineate the Intensive Care Activities to be undertaken to address key issues of risk for the member.
Plan of Care. A person-centered care plan that addresses acute care and LTSS for Enrollees. The plan is developed by the STAR+PLUS MMP Service Coordinator with the Enrollee, his/her family and caregiver supports, as appropriate, and Providers. The Plan of Care will contain the Enrollee’s health history; a summary of current, short- term, and long-term health and social needs, concerns, and goals; and a list of required services, their frequency, and a description of who will provide such services. For Enrollees eligible for HCBS, the Enrollee’s ISP is incorporated into the Plan of Care.
Plan of Care. I will work together with my JACC Care Manager to create a Plan of Care. This Plan of Care, and availability of services, will determine which services I receive. o I will receive a completed copy of the Plan of Care. o The Plan of Care will be revisited for potential revisions at least once annually. The Plan of Care can change more frequently, depending on my care needs, personal goals, service availability, and funding availability. o The JACC program will not provide any services which are not listed in my Plan of Care (POC). • Service limitations: Services are limited to a capped monthly budget and are provided by contracted providers. o Exceptions to the monthly budget may be made based on need and funding availability for specific, short-term expenses. o If there is no contracted provider for the needed service in the area, every effort will be made to contract with new providers. If no provider is able or willing to contract for the service, then the service cannot be provided through the JACC program. o If the required service is outside of the scope of the JACC program or the monthly budget, my JACC Care Manager will work with me to find an alternative way to secure the service.
Plan of Care. Provider will regularly communicate with Company regarding the care of Clients, changes, and response to actions as defined in each Client’s plan of care created by Provider via the applicable Client Needs Assessment. Provider further agrees to complete and provide an updated Clients Needs Assessment within fourteen (14) days of any observed changes to the client’s needs or upon the request of Company. Provider further agrees to immediately notify Company upon learning of any change in Client’s well-being that impacts their quality of life or care (e.g., hospitalization, significant change in Client’s health, Client refusing care or expresses a change in needs). Provider further agrees to investigate and document any complaints by the Client and provide said information to Company within ten (10) days of the complaint.
