Requirements for Lead Care Managers Sample Clauses

Requirements for Lead Care Managers. The MMP will assign an LCM to each Enrollee who is eligible for community LTSS or who is determined to be at high risk for poor health outcomes and/or high costs associated with health care delivery. Such Enrollees will be eligible to receive ICM services. For Enrollees with a primarily medical condition(s), a qualified individual with physical health expertise shall be designated as the LCM. For individuals with a primary mental illness or substance use disorder, a qualified individual with behavioral health expertise shall be designated as the LCM. Regardless of whether the primary expertise of the LCM is in physical or behavioral health, all ICM is intended to be holistic and person-centered, and not restricted to solely physical or behavioral health. When necessary, the MMP will make physical health Care Management resources available to the primary behavioral health LCMs, and vice versa, to meet the comprehensive needs of Enrollees. The MMP shall establish the role and responsibilities of each type of LCM. The MMP will maintain policies and procedures for assigning LCMs to manage the delivery of ICM services in a manner that ensures that Enrollees are served by the staff best qualified to meet their needs. In the event that Enrollees wish to select different LCMs, the MMP shall help them do so. The MMP is expected to leverage existing care management supports that may already be in place. These supports may include a nurse care manager in a primary care practice where the Enrollee receives primary care. i. The LCM will: a. Conduct the CFNA (to the extent that the MMP has sufficient information to assign an LCM with appropriate expertise to an Enrollee prior to full CFNA results) and fully incorporate such results into the Enrollee’s ICP. If the MMP does not have sufficient information to assign an LCM to an Enrollee prior to the CFNA, a qualified LCM will perform the CFNA and another LCM with expertise more relevant to the Enrollee’s needs may be assigned after the CFNA is completed; b. Discuss the Enrollee’s desired treatment results and outcomes; c. Oversee creation of the ICT with appropriate participants, reflecting both in- and out-of-plan services, as appropriate; d. Convene a telephonic or in-person meeting of the ICT, if appropriate and necessary, to discuss Enrollee needs and preferences; e. Hold in-person or telephonic ICT meeting(s) on an as needed basis, including any time an Enrollee experiences a significant change in condition (e.g. hos...