Common use of Required Services Clause in Contracts

Required Services. a. Mental Health Targeted Case Management services include working with the recipient and the recipient’s natural support system to develop and promote a needs assessment-based service plan. The service plan reflects the services or supports needed to meet the needs identified in an individualized assessment of the following areas: education or employment, physical health, mental health, substance abuse, social skills, independent living skills, and support system status. The approach used should identify and utilize the strengths, abilities, cultural characteristics, and informal supports of the recipient, family, and other natural support systems. Targeted case managers focus on overcoming barriers by collaborating and coordinating with other service providers and the recipient to assist in the attainment of service plan goals. The targeted case manager takes the lead in both coordinating services/treatment and assessing the effectiveness of services provided. b. When targeted case management recipients enrolled in the prepaid mental health plan are hospitalized in an acute care setting, state mental hospital, or are incarcerated in a forensic or corrections facility, the provider shall maintain contact with the individual and shall participate actively in the discharge planning processes and assist recipients in corrections facilities with immediate access to care upon return to the community. c. Case managers are responsible for coordination and collaboration with the Department of Children and Families, or the community based care provider contracted with the department, for services provided to children who are in the care or custody of the state. The provider shall make reasonable efforts to assure that prepaid mental health plan recipients who are in the care or custody of the state and who receive mental health targeted case management services have all services covered by the plan integrated with the case plans developed by the department. This integration shall reflect active collaboration with the department. d. Case managers are also responsible for coordination and collaboration with the parents or guardians of children who receive mental health targeted case management services. The provider shall make reasonable efforts to assure that case managers include the parents or guardians of prepaid mental health plan children in the process of providing targeted case management services. Integration of the parent’s input and involvement with the case manager and other providers shall be reflected in clinical record documentation and monitored through the agency’s quality of care monitoring activities.

Required Services. a. Mental Health Targeted Case Management (1) Behavioral health targeted case management services include working with the recipient enrollee and the recipientenrollee’s natural support system to develop and promote a needs assessment-based service plan. The service plan reflects the services or supports needed to meet the needs identified in an individualized assessment of the following areas: education or employment, physical health, mental health, substance abuse, social skills, independent living skills, and support system status. The approach used should shall identify and utilize the strengths, abilities, cultural characteristics, and informal supports of the recipientenrollee, family, and other natural support systems. Targeted case managers focus on overcoming barriers by collaborating and coordinating with other service providers and the recipient enrollee to assist in the attainment of service plan goals. The targeted case manager takes the lead in both coordinating services/treatment and assessing the effectiveness of the services provided. b. (2) When targeted case management recipients enrolled in the prepaid mental health plan Health Plan are hospitalized in an acute care setting, state mental hospital, setting or are incarcerated held in a forensic county jail or corrections juvenile detention facility, the provider Health Plan shall maintain document efforts to ensure that contact is maintained with the individual enrollee and shall participate actively in the discharge planning processes and assist recipients in corrections facilities with immediate access to care upon return to the communityprocesses. c. Case managers are responsible for coordination and collaboration with the Department of Children and Families, or the community based care provider contracted with the department, for services provided to children who are in the care or custody of the state. The provider shall make reasonable efforts to assure that prepaid mental health plan recipients who are in the care or custody of the state and who receive mental health targeted case management services have all services covered by the plan integrated with the case plans developed by the department. This integration shall reflect active collaboration with the department. d. (3) Case managers are also responsible for coordination and collaboration with the parents or guardians of children children/adolescents who receive mental health targeted case management services. The provider Health Plan shall make reasonable efforts monitor case management activities to assure that case managers routinely include the parents or guardians of prepaid mental health plan children enrollees in the process of providing targeted case management services. Integration of the parent’s input and involvement with the case manager and other providers shall be reflected in clinical medical record documentation and monitored through the agencyHealth Plan’s quality of care monitoring activities. Involvement with the child/adolescent’s school and/or childcare center must also be a component of case management with children/adolescents. (4) The Health Plan shall provide behavioral health targeted case management services to children/adolescents in the care or custody of the state who need them. The Health Plan shall document efforts to develop a cooperative agreement with DCF, or its provider of community-based services, to address how to minimize duplication of case management services and to promote the establishment of one case manager for the child/adolescent and family whenever possible.

Required Services. a. (1) Mental Health Targeted Case Management health targeted case management services include working with the recipient enrollee and the recipientenrollee’s natural support system to develop and promote a needs assessment-based service plan. The service plan reflects the services or supports needed to meet the needs identified in an individualized assessment of the following areas: education or employment, physical health, mental health, substance abuse, social skills, independent living skills, and support system status. The approach used should shall identify and utilize the strengths, abilities, cultural characteristics, and informal supports of the recipientenrollee, family, and other natural support systems. Targeted case managers focus on overcoming barriers by collaborating and coordinating with other service providers and the recipient enrollee to assist in the attainment of service plan goals. The targeted case manager takes the lead in both coordinating services/treatment and assessing the effectiveness of the services provided. b. (2) When targeted case management recipients enrolled in the prepaid mental health plan Health Plan are hospitalized in an acute care setting, state mental hospital, setting or are incarcerated held in a forensic county jail or corrections juvenile detention facility, the provider Health Plan shall maintain document efforts to ensure that contact is maintained with the individual enrollee and shall participate actively in the discharge planning processes and assist recipients in corrections facilities with immediate access to care upon return to the communityprocesses. c. Case managers are responsible for coordination and collaboration with the Department of Children and Families, or the community based care provider contracted with the department, for services provided to children who are in the care or custody of the state. The provider shall make reasonable efforts to assure that prepaid mental health plan recipients who are in the care or custody of the state and who receive mental health targeted case management services have all services covered by the plan integrated with the case plans developed by the department. This integration shall reflect active collaboration with the department. d. (3) Case managers are also responsible for coordination and collaboration with the parents or guardians of children children/adolescents who receive mental health targeted case management services. The provider Health Plan shall make reasonable efforts monitor case management activities to assure that case managers routinely include the parents or guardians of prepaid mental health plan children enrollees in the process of providing targeted case management services. Integration of the parent’s input and involvement with the case manager and WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract other providers shall be reflected in clinical medical record documentation and monitored through the agencyHealth Plan’s quality of care monitoring activities. Involvement with the child/adolescent’s school and/or childcare center must also be a component of case management with children/adolescents. (4) The Health Plan shall provide mental health targeted case management services to children/adolescents in the care or custody of the state who need them. The Health Plan shall document efforts to develop a cooperative agreement with DCF, or its provider of community-based services, to address how to minimize duplication of case management services and to promote the establishment of one case manager for the child/adolescent and family whenever possible.

Required Services. a. Mental Health Targeted Case Management (1) Behavioral health targeted case management services include working with the recipient enrollee and the recipientenrollee’s natural support system to develop and promote a needs assessment-based service plan. The service plan reflects the services or supports needed to meet the needs identified in an individualized assessment of the following areas: education or employment, physical health, mental health, substance abuse, social skills, independent living skills, and support system status. The approach used should shall identify and utilize the strengths, abilities, cultural characteristics, and informal supports of the recipientenrollee, family, and other natural support systems. Targeted case managers focus on overcoming barriers by collaborating and coordinating with other service providers and the recipient enrollee to assist in the attainment of service plan goals. The targeted case manager takes the lead in both coordinating services/treatment and assessing the effectiveness of the services provided.. AMERIGROUP Florida, Inc. d/b/a Medicaid Non-Reform and Reform AMERIGROUP Community Care HMO Contract b. (2) When targeted case management recipients enrolled in the prepaid mental health plan Health Plan are hospitalized in an acute care setting, state mental hospital, setting or are incarcerated held in a forensic county jail or corrections juvenile detention facility, the provider Health Plan shall maintain document efforts to ensure that contact is maintained with the individual enrollee and shall participate actively in the discharge planning processes and assist recipients in corrections facilities with immediate access to care upon return to the communityprocesses. c. Case managers are responsible for coordination and collaboration with the Department of Children and Families, or the community based care provider contracted with the department, for services provided to children who are in the care or custody of the state. The provider shall make reasonable efforts to assure that prepaid mental health plan recipients who are in the care or custody of the state and who receive mental health targeted case management services have all services covered by the plan integrated with the case plans developed by the department. This integration shall reflect active collaboration with the department. d. (3) Case managers are also responsible for coordination and collaboration with the parents or guardians of children children/adolescents who receive mental health targeted case management services. The provider Health Plan shall make reasonable efforts monitor case management activities to assure that case managers routinely include the parents or guardians of prepaid mental health plan children enrollees in the process of providing targeted case management services. Integration of the parent’s input and involvement with the case manager and other providers shall be reflected in clinical medical record documentation and monitored through the agencyHealth Plan’s quality of care monitoring activities. Involvement with the child/adolescent’s school and/or childcare center must also be a component of case management with children/adolescents. (4) The Health Plan shall provide behavioral health targeted case management services to children/adolescents in the care or custody of the state who need them. The Health Plan shall document efforts to develop a cooperative agreement with DCF, or its provider of community-based services, to address how to minimize duplication of case management services and to promote the establishment of one case manager for the child/adolescent and family whenever possible.