Common use of Policies and Procedures Regarding Member Safety and Risk Clause in Contracts

Policies and Procedures Regarding Member Safety and Risk. The MCO shall have policies and procedures in place regarding member safety and risk, which shall be submitted to the Department for approval prior to implementation, whenever a change occurs, and upon request. MCO staff and other appropriate individuals shall be informed of these policies on an ongoing basis. The purpose of these policies and procedures is to balance member needs for safety, protection, good physical health and freedom from accidents, with over-all quality of life and individual choice and freedom. These policies and procedures shall identify: How IDT staff will assess and respond to risk factors affecting members’ health and safety; Guidelines for use by IDT staff in balancing member rights with member safety through a process of ongoing negotiation and joint problem solving; Criteria for use by IDT staff to identify vulnerable/high risk members as defined in Article I.138; Training for all IDT staff in identifying risk and coordinating care with VHRM; Guidelines and tools to assist IDT staff in identifying and mitigating risk for VHRM; and Protocols for use by IDT staff to identify, implement and document appropriate, individualized monitoring and safeguards to address and mitigate potential concerns and assure the health and safety of members identified as vulnerable/high risk as defined in Article I.138. At a minimum these protocols must include: Documentation of ongoing assessment of risk and conflict of interest, as required under sections V.C.3.b.iv., VIII.N.2.c. and X.B.8.d. of this Contract; Assessment of caregiver stress using caregiver stress tool; Validation of backup plans to assure caregivers who have been identified are capable and willing to provide support as documented in the comprehensive assessment and member centered plan; Validation by appropriate MCO staff or arrangement for validation of supportive home care workers pursuant to the Managed Care Organization Training and Documentation Standards for Supportive Home Care xxxxx://xxx.xxx.xxxxxxxxx.xxx/publications/p01602.pdf within 10 days of enrollment; Documented attempts to collect data and information from the member's support network, including primary care and other health care providers, caregivers identified in the backup plan, and other significant people who regularly see the member to determine if there are any areas of concern or need that IDT staff should consider in connection with their duty to monitor and coordinate services as required in section V.E.4. of this Contract; Considerations of how to add additional external caregivers, as appropriate, to provide additional risk mitigation.

Policies and Procedures Regarding Member Safety and Risk. The MCO shall have policies and procedures in place regarding member safety and risk, which shall be submitted to the Department for approval prior to implementation, whenever a change occurs, and upon request. MCO staff and other appropriate individuals shall be informed of these policies on an ongoing basis. The purpose of these policies and procedures is to balance member needs for safety, protection, good physical health and freedom from accidents, with over-all quality of life and individual choice and freedom. These policies and procedures shall identify: How IDT staff will assess and respond to risk factors affecting members’ health and safety; Guidelines for use by IDT staff in balancing member rights with member safety through a process of ongoing negotiation and joint problem solving; Criteria for use by IDT staff to identify risk, including vulnerable/high risk members as defined in Article I.138I.139; Training for all IDT staff in identifying risk and coordinating care with VHRMcare; Guidelines and tools to assist IDT staff in identifying and mitigating risk for VHRMrisk; and Protocols for use by IDT staff to identify, implement and document appropriate, individualized monitoring and safeguards to address and mitigate potential concerns and assure the health and safety of all members including those identified as vulnerable/high risk as defined in Article I.138I.139. At a minimum these protocols must include: Documentation of ongoing assessment of risk and conflict of interest, as required under sections V.C.3.b.iv., VIII.N.2.c. and X.B.8.d. of this Contract; Assessment of caregiver stress using caregiver stress tool; Validation of backup plans to assure caregivers who have been identified are capable and willing to provide support as documented in the comprehensive assessment and member member- centered plan; Validation by appropriate MCO staff or arrangement for validation of supportive home care workers pursuant to the Managed Care Organization Training and Documentation Standards for Supportive Home Care xxxxx://xxx.xxx.xxxxxxxxx.xxx/publications/p01602.pdf within 10 days of enrollment; Documented attempts to collect data and information from the member's support network, including primary care and other health care providers, caregivers identified in the backup plan, and other significant people who regularly see the member to determine if there are any areas of concern or need that IDT staff should consider in connection with their duty to monitor and coordinate services as required in section V.E.4. of this Contract; Considerations of how to add additional external caregivers, as appropriate, to provide additional risk mitigation. Training and guidance for IDT staff that at every in-person contact, the IDT staff are required to check and document in the chart that each member with a Behavioral Support Plan (BSP) and/or Restrictive Measure have an effective, up to date BSP and/or Restrictive Measure in place and that residential provider staff are trained and following the BSP and/or Restrictive Measure appropriately. Abuse, Neglect, Exploitation and Mistreatment Prohibited The MCO shall implement a policy that expressly prohibits all forms of abuse, neglect, exploitation and mistreatment of members by MCO employees and contracted providers. This policy shall include instruction in recognizing abuse, neglect and exploitation, mandated reporting responsibilities, and the proper reporting procedures when abuse or neglect is suspected.

Policies and Procedures Regarding Member Safety and Risk. The MCO PO shall have policies and procedures in place regarding member safety and risk, which shall be submitted to the Department for approval prior to implementation, whenever a change occurs, and upon request. MCO PO staff and other appropriate individuals shall be informed of these policies on an ongoing basis. The purpose of these policies and procedures is to balance member needs for safety, protection, good physical health and freedom from accidents, with over-all quality of life and individual choice and freedom. These policies and procedures shall identify: How IDT staff will assess and respond to risk factors affecting members’ health and safety; Guidelines for use by IDT staff in balancing member rights with member safety through a process of ongoing negotiation and joint problem solving; Criteria for use by IDT staff to identify risk, including vulnerable/high risk members as defined in Article I.138I.131; Training for all IDT staff in identifying risk and coordinating care with VHRMcare; Guidelines and tools to assist IDT staff in identifying and mitigating risk for VHRMrisk; and Protocols for use by IDT staff to identify, implement and document appropriate, individualized monitoring and safeguards to address and mitigate potential concerns and assure the health and safety of all members including those identified as vulnerable/high risk as defined in Article I.138I.131. At a minimum these protocols must include: Documentation of ongoing assessment of risk and conflict of interest, as required under sections V.C.3.b.iv., VIII.N.2.c. and X.B.8.d. of this Contract; Assessment of caregiver stress using caregiver stress tool; Validation of backup plans to assure caregivers who have been identified are capable and willing to provide support as documented in the comprehensive assessment and member centered plan; Validation by appropriate MCO PO staff or arrangement for validation of supportive home care workers pursuant to the Managed Care Organization Training and Documentation Standards for Supportive Home Care xxxxx://xxx.xxx.xxxxxxxxx.xxx/publications/p01602.pdf within 10 days of enrollment; Documented attempts to collect data and information from the member's support network, including primary care and other health care providers, caregivers identified in the backup plan, and other significant people who regularly see the member to determine if there are any areas of concern or need that IDT staff should consider in connection with their duty to monitor and coordinate services as required in section V.E.4. of this Contract; Considerations of how to add additional external caregivers, as appropriate, to provide additional risk mitigation.

Policies and Procedures Regarding Member Safety and Risk. The MCO shall have policies and procedures in place regarding member safety and risk, which shall be submitted to the Department for approval prior to implementation, whenever a change occurs, and upon request. MCO staff and other appropriate individuals shall be informed of these policies on an ongoing basis. The purpose of these policies and procedures is to balance member needs for safety, protection, good physical health and freedom from accidents, with over-all quality of life and individual choice and freedom. These policies and procedures shall identify: How IDT staff will assess and respond to risk factors affecting members’ health and safety; Guidelines for use by IDT staff in balancing member rights with member safety through a process of ongoing negotiation and joint problem solving; Criteria for use by IDT staff to identify risk, including vulnerable/high risk members as defined in Article I.138I.139; Training for all IDT staff in identifying risk and coordinating care with VHRMcare; Guidelines and tools to assist IDT staff in identifying and mitigating risk for VHRMrisk; and Protocols for use by IDT staff to identify, implement and document appropriate, individualized monitoring and safeguards to address and mitigate potential concerns and assure the health and safety of all members including those identified as vulnerable/high risk as defined in Article I.138I.139. At a minimum these protocols must include: Documentation of ongoing assessment of risk and conflict of interest, as required under sections V.C.3.b.iv., VIII.N.2.c. and X.B.8.d. of this Contract; Assessment of caregiver stress using caregiver stress tool; Validation of backup plans to assure caregivers who have been identified are capable and willing to provide support as documented in the comprehensive assessment and member centered plan; Validation by appropriate MCO staff or arrangement for validation of supportive home care workers pursuant to the Managed Care Organization Training and Documentation Standards for Supportive Home Care xxxxx://xxx.xxx.xxxxxxxxx.xxx/publications/p01602.pdf within 10 days of enrollment; Documented attempts to collect data and information from the member's support network, including primary care and other health care providers, caregivers identified in the backup plan, and other significant people who regularly see the member to determine if there are any areas of concern or need that IDT staff should consider in connection with their duty to monitor and coordinate services as required in section V.E.4. of this Contract; Considerations of how to add additional external caregivers, as appropriate, to provide additional risk mitigation. Training and guidance for IDT staff that at every in-person contact, the IDT staff are required to check and document in the chart that each member with a Behavioral Support Plan (BSP) and/or Restrictive Measure have an effective, up to date BSP and/or Restrictive Measure in place and that residential provider staff are trained and following the BSP and/or Restrictive Measure appropriately. Abuse, Neglect, Exploitation and Mistreatment Prohibited The MCO shall implement a policy that expressly prohibits all forms of abuse, neglect, exploitation and mistreatment of members by MCO employees and contracted providers. This policy shall include instruction in recognizing abuse, neglect and exploitation, mandated reporting responsibilities, and the proper reporting procedures when abuse or neglect is suspected.

Policies and Procedures Regarding Member Safety and Risk. The MCO PO shall have policies and procedures in place regarding member safety and risk, which shall be submitted to the Department for approval prior to implementation, whenever a change occurs, and upon request. MCO PO staff and other appropriate individuals shall be informed of these policies on an ongoing basis. The purpose of these policies and procedures is to balance member needs for safety, protection, good physical health and freedom from accidents, with over-all quality of life and individual choice and freedom. These policies and procedures shall identify: How IDT staff will assess and respond to risk factors affecting members’ health and safety; Guidelines for use by IDT staff in balancing member rights with member safety through a process of ongoing negotiation and joint problem solving; Criteria for use by IDT staff to identify risk, including vulnerable/high risk members as defined in Article I.138I.140; Training for all IDT staff in identifying risk and coordinating care with VHRMcare; Guidelines and tools to assist IDT staff in identifying and mitigating risk for VHRMrisk; and Protocols for use by IDT staff to identify, implement and document appropriate, individualized monitoring and safeguards to address and mitigate potential concerns and assure the health and safety of all members including those identified as vulnerable/high risk as defined in Article I.138I.140. At a minimum these protocols must include: Documentation of ongoing assessment of risk and conflict of interest, as required under sections V.C.3.b.iv., VIII.N.2.c. and X.B.8.d. of this Contract; Assessment of caregiver stress using caregiver stress tool; Validation of backup plans to assure caregivers who have been identified are capable and willing to provide support as documented in the comprehensive assessment and member member- centered plan; Validation by appropriate MCO PO staff or arrangement for validation of supportive home care workers pursuant to the Managed Care Organization Training and Documentation Standards for Supportive Home Care xxxxx://xxx.xxx.xxxxxxxxx.xxx/publications/p01602.pdf within 10 days of enrollment; Documented attempts to collect data and information from the member's support network, including primary care and other health care providers, caregivers identified in the backup plan, and other significant people who regularly see the member to determine if there are any areas of concern or need that IDT staff should consider in connection with their duty to monitor and coordinate services as required in section V.E.4. of this Contract; Considerations of how to add additional external caregivers, as appropriate, to provide additional risk mitigation. Training and guidance for IDT staff that at every in-person contact, the IDT staff are required to check and document in the chart that each member with a Behavioral Support Plan (BSP) and/or Restrictive Measure have an effective, up to date BSP and/or Restrictive Measure in place and that residential provider staff are trained and following the BSP and/or Restrictive Measure appropriately. Abuse, Neglect, Exploitation and Mistreatment Prohibited The PO shall implement a policy that expressly prohibits all forms of abuse, neglect, exploitation and mistreatment of members by PO employees and contracted providers. This policy shall include instruction in the proper reporting procedures when abuse or neglect is suspected.

Policies and Procedures Regarding Member Safety and Risk. The MCO PO shall have policies and procedures in place regarding member safety and risk, which shall be submitted to the Department for approval prior to implementation, whenever a change occurs, and upon request. MCO PO staff and other appropriate individuals shall be informed of these policies on an ongoing basis. The purpose of these policies and procedures is to balance member needs for safety, protection, good physical health and freedom from accidents, with over-all quality of life and individual choice and freedom. These policies and procedures shall identify: How IDT staff will assess and respond to risk factors affecting members’ health and safety; Guidelines for use by IDT staff in balancing member rights with member safety through a process of ongoing negotiation and joint problem solving; Criteria for use by IDT staff to identify risk, including vulnerable/high risk members as defined in Article I.138I.131; Training for all IDT staff in identifying risk and coordinating care with VHRMcare; Guidelines and tools to assist IDT staff in identifying and mitigating risk for VHRMrisk; and Protocols for use by IDT staff to identify, implement and document appropriate, individualized monitoring and safeguards to address and mitigate potential concerns and assure the health and safety of all members including those identified as vulnerable/high risk as defined in Article I.138I.131. At a minimum these protocols must include: Documentation of ongoing assessment of risk and conflict of interest, as required under sections V.C.3.b.iv., VIII.N.2.c. and X.B.8.d. of this Contract; Assessment of caregiver stress using caregiver stress tool; Validation of backup plans to assure caregivers who have been identified are capable and willing to provide support as documented in the comprehensive assessment and member centered plan; Validation by appropriate MCO PO staff or arrangement for validation of supportive home care workers pursuant to the Managed Care Organization Training and Documentation Standards for Supportive Home Care xxxxx://xxx.xxx.xxxxxxxxx.xxx/publications/p01602.pdf within 10 days of enrollment; Documented attempts to collect data and information from the member's support network, including primary care and other health care providers, caregivers identified in the backup plan, and other significant people who regularly see the member to determine if there are any areas of concern or need that IDT staff should consider in connection with their duty to monitor and coordinate services as required in section V.E.4. of this Contract; Considerations of how to add additional external caregivers, as appropriate, to provide additional risk mitigation. Training and guidance for IDT staff that at every in-person contact, the IDT staff are required to check and document in the chart that each member with a Behavioral Support Plan (BSP) and/or Restrictive Measure have an effective, up to date BSP and/or Restrictive Measure in place and that residential provider staff are trained and following the BSP and/or Restrictive Measure appropriately. Abuse, Neglect, Exploitation and Mistreatment Prohibited The PO shall implement a policy that expressly prohibits all forms of abuse, neglect, exploitation and mistreatment of members by PO employees and contracted providers. This policy shall include instruction in the proper reporting procedures when abuse or neglect is suspected.

Policies and Procedures Regarding Member Safety and Risk. The MCO shall have policies and procedures in place regarding member safety and risk, which shall be submitted to the Department for approval prior to implementation, whenever a change occurs, and upon request. MCO staff and other appropriate individuals shall be informed of these policies on an ongoing basis. The purpose of these policies and procedures is to balance member needs for safety, protection, good physical health and freedom from accidents, with over-all quality of life and individual choice and freedom. These policies and procedures shall identify: How IDT staff will assess and respond to risk factors affecting members’ health and safety; Guidelines for use by IDT staff in balancing member rights with member safety through a process of ongoing negotiation and joint problem solving; Criteria for use by IDT staff to identify risk, including vulnerable/high risk members as defined in Article I.138I.137; Training for all IDT staff in identifying risk and coordinating care with VHRMcare; Guidelines and tools to assist IDT staff in identifying and mitigating risk for VHRMrisk; and Protocols for use by IDT staff to identify, implement and document appropriate, individualized monitoring and safeguards to address and mitigate potential concerns and assure the health and safety of all members including those identified as vulnerable/high risk as defined in Article I.138I.137. At a minimum these protocols must include: Documentation of ongoing assessment of risk and conflict of interest, as required under sections V.C.3.b.iv., VIII.N.2.c. and X.B.8.dX.B.8.h. of this Contract; Assessment of caregiver stress using caregiver stress tool; Validation of backup plans to assure caregivers who have been identified are capable and willing to provide support as documented in the comprehensive assessment and member centered plan; Validation by appropriate MCO staff or arrangement for validation of supportive home care workers pursuant to the Managed Care Organization Training and Documentation Standards for Supportive Home Care xxxxx://xxx.xxx.xxxxxxxxx.xxx/publications/p01602.pdf within 10 days of enrollment; Documented attempts to collect data and information from the member's support network, including primary care and other health care providers, caregivers identified in the backup plan, and other significant people who regularly see the member to determine if there are any areas of concern or need that IDT staff should consider in connection with their duty to monitor and coordinate services as required in section V.E.4. of this Contract; Considerations of how to add additional external caregivers, as appropriate, to provide additional risk mitigation.

Policies and Procedures Regarding Member Safety and Risk. The MCO shall have policies and procedures in place regarding member safety and risk, which shall be submitted to the Department for approval prior to implementation, whenever a change occurs, and upon request. MCO staff and other appropriate individuals shall be informed of these policies on an ongoing basis. The purpose of these policies and procedures is to balance member needs for safety, protection, good physical health and freedom from accidents, with over-all quality of life and individual choice and freedom. These policies and procedures shall identify: How IDT staff will assess and respond to risk factors affecting members’ health and safety; Guidelines for use by IDT staff in balancing member rights with member safety through a process of ongoing negotiation and joint problem solving; Criteria for use by IDT staff to identify risk, including vulnerable/high risk members as defined in Article I.138I.137; Training for all IDT staff in identifying risk and coordinating care with VHRMcare; Guidelines and tools to assist IDT staff in identifying and mitigating risk for VHRMrisk; and Protocols for use by IDT staff to identify, implement and document appropriate, individualized monitoring and safeguards to address and mitigate potential concerns and assure the health and safety of all members including those identified as vulnerable/high risk as defined in Article I.138I.137. At a minimum these protocols must include: Documentation of ongoing assessment of risk and conflict of interest, as required under sections V.C.3.b.iv., VIII.N.2.c. and X.B.8.d. of this Contract; Assessment of caregiver stress using caregiver stress tool; Validation of backup plans to assure caregivers who have been identified are capable and willing to provide support as documented in the comprehensive assessment and member centered plan; Validation by appropriate MCO staff or arrangement for validation of supportive home care workers pursuant to the Managed Care Organization Training and Documentation Standards for Supportive Home Care xxxxx://xxx.xxx.xxxxxxxxx.xxx/publications/p01602.pdf within 10 days of enrollment; Documented attempts to collect data and information from the member's support network, including primary care and other health care providers, caregivers identified in the backup plan, and other significant people who regularly see the member to determine if there are any areas of concern or need that IDT staff should consider in connection with their duty to monitor and coordinate services as required in section V.E.4. of this Contract; Considerations of how to add additional external caregivers, as appropriate, to provide additional risk mitigation.