State Level Delivery System Requirements a. Provision of Integrated Care Services
State Level Delivery System Requirements. Delivery system and care model requirements will continue to be established through separate Medicare Advantage Special Needs Plan contracts and State Medicaid contracts with the MSHO Plans. However, the following reforms and administrative changes will be implemented to the delivery system to enhance the Beneficiary experience under MSHO:
State Level Delivery System Requirements. A. State Requirements for Care Management - Care management services must be available to all Enrollees. Participating Plans must address the following components as part of their comprehensive programs. Through the readiness review process, CMS and the Commonwealth will review Participating Plans’ capacity to deliver care management services. The Commonwealth will also review and approve the Participating Plans’ care management programs to ensure that all of the following required components are adequately addressed.
State Level Delivery System Requirements a. State Requirements for Care Management - Care management services will be available to all ICDS Enrollees. ICDS Plans will be expected to address the following components as part of their comprehensive programs. Through the readiness review process, CMS and the State will review ICDS Plan capacity to deliver care management services. The State will also review and approve the ICDS plans’ care management programs to ensure that all required components are adequately addressed.
State Level Delivery System Requirements. A. Requirements for Care Management and Care Coordination: MMPs will offer Care Management services to all Enrollees as needed to support health and wellness, ensure effective linkages and coordination between the primary care provider (PCP) and other providers and services, and to coordinate the full range of medical and behavioral health services, preventive services, medications, LTSS, social supports, and enhanced benefits as needed, both within and outside the MMP. Care Management services include both Intensive Care Management (ICM) for Enrollees who are eligible for LTSS and other high-risk Enrollees who may benefit from such services, and Care Coordination services for individuals with more limited needs. All Care Management services will be person-centered and will be delivered to Enrollees according to their strength-based needs and preferences. Enrollees will be encouraged to participate in decision making with respect to their care. MMPs shall have effective systems, policies, procedures and practices in place to identify Enrollees in need of Care Management services, including an early warning system and procedures that xxxxxx proactive identification of high-risk Enrollees and to further identify Enrollees’ emerging needs. A determination of which Enrollees are at high risk will be made by the MMP as a result of its predictive modeling results, Initial Health Screen or Comprehensive Functional Needs Assessment, and/or State-established minimum required determinants of health status, as described below. Enrollees who are determined to be at high-risk and eligible for ICM may include, but not be limited to, individuals with complex medical conditions and/or social support needs that may lead to: the need for high-cost services; deterioration in health status; or, institutionalization.
State Level Delivery System Requirements a. State Requirements for Care Management – Care management services will be available to all FIDA Demonstration Participants through the FIDA Plan’s Interdisciplinary Team (IDT) model as outlined in the Three-way Contract. FIDA Plans will be expected to address the following components as part of their comprehensive care management programs. Through the readiness review process, CMS and the State will review FIDA Plan capacity to deliver care management services using the IDT model. The CMS and the State will also review and approve the FIDA Plans’ care management programs to ensure that all required components are adequately addressed.
State Level Delivery System Requirements a. State Requirements for Care Coordination –The ICOs will develop and implement a strategy that uses a combination of initial screenings, assessments, health risk assessment tools, functional assessments, referrals, administrative claims data, etc. to help prioritize and determine the level of care coordination needed by each enrollee. ICOs may also choose to use existing predictive modeling software to support the screening and assessment requirements but will not be required to do so. Care Coordination services will be available to all ICO enrollees. ICOs will be required to contract with Prepaid Inpatient Health Plans (PIHP) to jointly coordinate and manage care for enrollees with behavioral health, substance use disorder and/or intellectual/developmental disabilities (BH, SUD, and/or I/DD) needs. The ICO-PIHP contract will be monitored by MDCH to ensure ICOs meet all delivery system requirements of the Demonstration and all enrollees receive the appropriate care coordination services.
State Level Delivery System Requirements. A. State Requirements for Care Management - Care management services will be available to all STAR+PLUS MMP enrollees. STAR+PLUS MMPs will be required to address the following components as part of their comprehensive care management programs as outlined below and in the three-way contract. Through the readiness review process, CMS and the State will review STAR+PLUS MMP capacity to deliver care management services.
State Level Delivery System Requirements
