Right Choices Program Level of Service Sample Clauses

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peers and/or exhibit drug-seeking behaviors. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The RCP follows the CMS design of a Patient Review and Restrict (PRR) program that is focused on behaviors of Doctor Shopping and excessive utilization of Controlled Substances, especially Opioids. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided on the State “Manuals” page (xxxxx://xxx.xx.xxx/medicaid/partners/medicaid- partners/managed-care-health-plans/mce-secure-landing-page/mce-manuals/). The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following: ▪ Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment; ▪ Document member enrollment and compliance in Portal; ▪ Enroll members in the RCP; ▪ Provide written notification of RCP status to such members and their assigned primary physicians and pharmacies; ▪ Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior; ▪ Provide appropriate customer service to providers and members; ▪ Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue; ▪ Notify FSSA of members that are being reported to the FSSA Bureau of Investigation for suspected or alleged fraudulent activities; ▪ Provide ad-hoc reports about RCP to FSSA upon request; ▪ Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA; ▪ Meet with FSSA about RCP prog...
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Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peers and/or exhibit drug-seeking behaviors. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The RCP follows the CMS design of a Patient Review and Restrict (PRR) program that is focused on behaviors of Doctor Shopping and excessive utilization of Controlled Substances, especially Opioids. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members.
Sample 1
Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peers and/or exhibit drug-seeking behaviors. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The RCP follows the CMS design of a Patient Review and Restrict (PRR) program that is focused on behaviors of Doctor Shopping and excessive utilization of Controlled Substances, especially Opioids. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in the Bidders’ Library. The
Sample 1

Related to Right Choices Program Level of Service

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