Support Broker Functions. The CONTRACTOR shall perform, or contract with a qualified vendor to perform, the SB functions for Members electing the SDCB. If the CONTRACTOR performs the support broker functions, in addition to its employed SBs, it must also offer the Member a choice of at least two additional SB agencies. If the CONTRACTOR does not perform the SB functions, it must offer the Member a choice of multiple contracted SB agencies. The CONTRACTOR shall be responsible for ensuring that all applicable requirements are met. At minimum, the CONTRACTOR (either directly or through a Subcontractor) shall perform the following SB functions: Educate Members on how to use self-directed supports and services and provide information on program changes or updates; Review, monitor and document progress of the Member’s SDCB services and budget; Assist in managing budget expenditures and complete and submit budget revision requests; Assist with employer functions, such as recruiting, hiring and supervising Providers; Assist with approving/processing job descriptions for direct supports; Assist with completing forms related to employees; Assist with approving timesheets and purchase orders or invoices for goods, obtaining quotes for services and goods, as well as identifying and negotiating with vendors; Assist with problem solving employee and vendor payment issues with the FMA and other relevant parties; Facilitate resolution of any disputes regarding payment to Providers for services rendered; Develop the care plan for SDCB services, based on the budget amount and ensure that it is included in the CCP; and Assist in completing all documentation required by the FMA. The CONTRACTOR shall have policies and procedures in place to ensure that SBs and care coordinators work in a collaborative manner, and do not duplicate activities or functions. The CONTRACTOR shall conduct an annual audit of the SB network to ensure that all above requirements and those outlined in the Managed Care Policy Manual are met. The CONTRACTOR shall work in collaboration with other MCOs to provide education and training to the FMA and its staff regarding key requirements of this Agreement. The CONTRACTOR shall conduct initial education and training to the FMA and its staff at least forty-five (45) Calendar Days prior to Go-Live. This education and training shall include, but not be limited to, the following: The role and responsibilities of the care coordinator, including, but not limited to, CNA and CCP development, CCP implementation and monitoring processes, including the development and activation of a back-up plan for Members participating in the SDCB; The FMA’s responsibilities for communicating with the CONTRACTOR, Members, EORs, Authorized Agents, Providers, HCA and the process by which to do this; Requirements and processes regarding referral to the FMA; Requirements and processes, including time frames for authorization of the SDCB; Requirements and processes, including time frames, for Claims submission and payment and coding requirements; Systems requirements and Health Information Exchange (HIE) requirements; HIPAA compliance; Turquoise Care program quality requirements; and EVV requirements and processes The CONTRACTOR shall provide ongoing FMA education, training and technical assistance as deemed necessary by the CONTRACTOR or HCA in order to ensure compliance with this Agreement. The CONTRACTOR shall provide to the FMA, in electronic format (including, but not limited to access via a web link) a Member handbook and updates thereafter annually or any time material changes are made. The care coordinator shall provide the Member with a self-assessment instrument developed by HCA. The self-assessment instrument shall be completed by the Member with assistance from the Member’s care coordinator as appropriate. The care coordinator shall file the completed self-assessment in the Member’s file. If, based on the results of the self-assessment, the care coordinator determines that a Member requires assistance to direct their services, the care coordinator shall inform the Member that he or she will need to designate an EOR to assume the self-direction functions on their behalf. The SB shall assist the Member/EOR in developing a back-up plan for the SDCB that adequately identifies how the Member/EOR will address situations when a scheduled provider is not available or fails to show up as scheduled. The CONTRACTOR shall file a copy of the back-up plan in the Member’s file. The Member’s SB shall assess the adequacy of the Member’s back- up plan on at least an annual basis and any time there are changes in the type, amount, duration, scope of the SDCB or the schedule at which such services are needed, changes in Providers (when such Providers also serve as a back-up to other Providers) or changes in the availability of paid or unpaid back-up Providers to deliver needed care.
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Samples: Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement
Support Broker Functions. The CONTRACTOR shall perform, or contract with a qualified vendor to perform, the SB functions for Members electing the SDCB. If the CONTRACTOR performs the support broker functions, in addition to its employed SBs, it must also offer the Member a choice of at least two additional SB agencies. If the CONTRACTOR does not perform the SB functions, it must offer the Member a choice of multiple contracted SB agencies. The CONTRACTOR shall be responsible for ensuring that all applicable requirements are met. At minimum, the CONTRACTOR (either directly or through a Subcontractor) shall perform the following SB functions: Educate Members on how to use self-directed supports and services and provide information on program changes or updates; Review, monitor and document progress of the Member’s SDCB services and budget; Assist in managing budget expenditures and complete and submit budget revision requests; Assist with employer functions, such as recruiting, hiring and supervising Providers; Assist with approving/processing job descriptions for direct supports; Assist with completing forms related to employees; Assist with approving timesheets and purchase orders or invoices for goods, obtaining quotes for services and goods, as well as identifying and negotiating with vendors; Assist with problem solving employee and vendor payment issues with the FMA and other relevant parties; Facilitate resolution of any disputes regarding payment to Providers for services rendered; Develop the care plan for SDCB services, based on the budget amount and ensure that it is included in the CCP; and Assist in completing all documentation required by the FMA. The CONTRACTOR shall have policies and procedures in place to ensure that SBs and care coordinators work in a collaborative manner, and do not duplicate activities or functions. The CONTRACTOR shall conduct an annual audit of the SB network to ensure that all above requirements and those outlined in the Managed Care Policy Manual are met. The CONTRACTOR shall work in collaboration with other MCOs to provide education and training to the FMA and its staff regarding key requirements of this Agreement. The CONTRACTOR shall conduct initial education and training to the FMA and its staff at least forty-five (45) Calendar Days prior to Go-Live. This education and training shall include, but not be limited to, the following: The role and responsibilities of the care coordinator, including, but not limited to, CNA and CCP development, CCP implementation and monitoring processes, including the development and activation of a back-up plan for Members participating in the SDCB; The FMA’s responsibilities for communicating with the CONTRACTOR, Members, EORs, Authorized Agents, Providers, HCA HSD and the process by which to do this; Requirements and processes regarding referral to the FMA; Requirements and processes, including time frames for authorization of the SDCB; Requirements and processes, including time frames, for Claims submission and payment and coding requirements; Systems requirements and Health Information Exchange (HIE) requirements; HIPAA compliance; Turquoise Care program quality requirements; and EVV requirements and processes The CONTRACTOR shall provide ongoing FMA education, training and technical assistance as deemed necessary by the CONTRACTOR or HCA HSD in order to ensure compliance with this Agreement. The CONTRACTOR shall provide to the FMA, in electronic format (including, but not limited to access via a web link) a Member handbook and updates thereafter annually or any time material changes are made. The care coordinator shall provide the Member with a self-assessment instrument developed by HCAHSD. The self-assessment instrument shall be completed by the Member with assistance from the Member’s care coordinator as appropriate. The care coordinator shall file the completed self-assessment in the Member’s file. If, based on the results of the self-assessment, the care coordinator determines that a Member requires assistance to direct their services, the care coordinator shall inform the Member that he or she will need to designate an EOR to assume the self-direction functions on their behalf. The SB shall assist the Member/EOR in developing a back-up plan for the SDCB that adequately identifies how the Member/EOR will address situations when a scheduled provider is not available or fails to show up as scheduled. The CONTRACTOR shall file a copy of the back-up plan in the Member’s file. The Member’s SB shall assess the adequacy of the Member’s back- up plan on at least an annual basis and any time there are changes in the type, amount, duration, scope of the SDCB or the schedule at which such services are needed, changes in Providers (when such Providers also serve as a back-up to other Providers) or changes in the availability of paid or unpaid back-up Providers to deliver needed care.
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