Common use of Team Composition Clause in Contracts

Team Composition. The interdisciplinary team (IDT) is the vehicle for providing member-centered care management. The full IDT always includes the member and other people specified by the member, as well as IDT staff. Throughout this article the term “IDT staff” refers to the social service coordinator, registered nurse and any other staff who are assigned or contracted by the MCO to participate in the IDT and is meant to distinguish those staff from the full IDT. 1. The member receives care management through designated IDT staff, which at a minimum include the following: a. For Family Care, a social service coordinator and a Wisconsin licensed registered nurse; b. For Partnership, a social service coordinator, a Wisconsin licensed registered nurse and a Wisconsin licensed nurse practitioner; c. For PACE, a Master’s level social worker, a Wisconsin licensed registered nurse, a Wisconsin licensed nurse practitioner and a primary care physician and other professional disciplines as defined in 42 C.F.R. § 460.102. The team may include additional persons with specialized expertise for assessment, consultation, ongoing coordination efforts and other assistance as needed. A “social service coordinator” is required to be a social worker certified in Wisconsin or have a minimum of a four-year bachelor’s degree in the human services area or a four-year bachelor’s degree in any other area with a minimum of three (3) years’ experience in social service care management or related social service experience with persons in the MCO’s target population. Individuals holding a position comparable to a social service coordinator at the time an MCO first contracts to deliver a managed long-term care program in a new service area or to a new target population may be exempted from this requirement at the discretion of the Department. 2. The IDT staff shall have knowledge of community alternatives for the target populations served by the MCO and the full range of long-term care resources. IDT staff shall also have specialized knowledge of the conditions and functional limitations of the target populations served by the MCO, and of the individual members to whom they are assigned. The MCO shall establish a means that ensures ease of access and a reasonable level of responsiveness for each member to their IDT staff during regular business hours. The Department recognizes that in the Partnership Program an MCO may encounter a shortage of available nurse practitioners. a. In order to make best use of the time of nurse practitioners while still assuring Partnership members have access to a nurse practitioner, an MCO may develop policies and procedures to apportion, in a way that is responsive to individual member needs, the time nurse practitioners work with the IDT of each individual member. Such policies and procedures may be guided by the needs of the population and could, under some circumstances use the time of a nurse practitioner solely to access prescriptions, provide triage services and as an educational resource for the IDT staff. All such policies and procedures will: i. Assure that every member’s IDT has some level of participation by a nurse practitioner; ii. Establish procedures for identifying the most appropriate level of participation by a nurse practitioner with the IDT of each individual member by taking into account the unique conditions and circumstances of the member; and iii. Assure that nurse practitioners are readily available to members who have the most need for advanced practice health care. b. On a case-by-case basis, the MCO may choose to use a physician assistant or advanced practice nurse prescriber with experience working with the target groups and with demonstrated capacity to work independently to fulfill the need for advanced practice health care. The MCO will continue to ensure each member has access to an appropriate level of advanced practice health care.

Team Composition. The interdisciplinary team (IDT) is the vehicle for providing member-centered care management. The full IDT always includes the member and other people specified by the member, as well as IDT staff. Throughout this article the term “IDT staff” refers to the social service coordinator, registered nurse and any other staff who are assigned or contracted by the MCO to participate in the IDT and is meant to distinguish those staff from the full IDT. 1. The member receives care management through designated IDT staff, which at a minimum include the following: a. For Family Care, a social service coordinator and a Wisconsin licensed registered nurse; b. For Partnership, a social service coordinator, a Wisconsin licensed registered nurse and a Wisconsin licensed nurse practitioner; c. For PACE, a Master’s level social worker, a Wisconsin licensed registered nurse, a Wisconsin licensed nurse practitioner and a primary care physician and other professional disciplines as defined in 42 C.F.R. § CFR 460.102. The team may include additional persons with specialized expertise for assessment, consultation, ongoing coordination efforts and other assistance as needed. A “social service coordinator” is required to be a social worker certified in Wisconsin or have a minimum of a four-year bachelor’s degree in the human services area or a four-year bachelor’s degree in any other area with a minimum of three (3) years’ years experience in social service care management or related social service experience with persons in the MCO’s target population. Individuals holding a position comparable to a social service coordinator at the time an MCO first contracts to deliver a managed long-term care program in a new service area or to a new target population may be exempted from this requirement at the discretion of the Department. 2. The IDT staff shall have knowledge of community alternatives for the target populations served by the MCO and the full range of long-term care resources. IDT staff shall also have specialized knowledge of the conditions and functional limitations of the target populations served by the MCO, and of the individual members to whom they are assigned. The MCO shall establish a means that ensures ease of access and a reasonable level of responsiveness for each member to their IDT staff during regular business hours. The Department recognizes that in the Partnership Program an MCO may encounter a shortage of available nurse practitioners. a. In order to make best use of the time of nurse practitioners while still assuring Partnership members have access to a nurse practitioner, an MCO may develop policies and procedures to apportion, in a way that is responsive to individual member needs, the time nurse practitioners work with the IDT of each individual member. Such policies and procedures may be guided by the needs of the population and could, under some circumstances use the time of a nurse practitioner solely to access prescriptions, provide triage services and as an educational resource for the IDT staff. All such policies and procedures will: i. Assure that every member’s IDT has some level of participation by a nurse practitioner; ii. Establish procedures for identifying the most appropriate level of participation by a nurse practitioner with the IDT of each individual member by taking into account the unique conditions and circumstances of the member; and iii. Assure that nurse practitioners are readily available to members who have the most need for advanced practice health care. b. On a case-by-case basis, basis the Department may approve a waiver to allow a Partnership MCO may choose to use a physician assistant or advanced practice nurse prescriber with experience working with the target groups and with demonstrated capacity to work independently to fulfill the need for advanced practice health care. This type of waiver request must demonstrate that the physician assistant or advanced practice nurse prescriber has experience working with the target groups and has demonstrated capacity to work independently. The MCO will continue to ensure request must also describe the strategy for assuring that the IDT of each member has access to an appropriate level of advanced practice health care.

Team Composition. The interdisciplinary team (IDT) is the vehicle for providing member-centered care management. The full IDT always includes the member and other people specified by the member, as well as IDT staff. Throughout this article the term “IDT staff” refers to the social service coordinator, registered nurse and any other staff who are assigned or contracted by the MCO to participate in the IDT and is meant to distinguish those staff from the full IDT. 1. The member receives care management through designated IDT staff, which at a minimum include the following: a. For Family Care, a social service coordinator and a Wisconsin licensed registered nurse; b. For Partnership, a social service coordinator, a Wisconsin licensed registered nurse and a Wisconsin licensed nurse practitioner; c. For PACE, a Master’s level social worker, a Wisconsin licensed registered nurse, a Wisconsin licensed nurse practitioner and a primary care physician and other professional disciplines as defined in 42 C.F.R. § CFR 460.102. The team may include additional persons with specialized expertise for assessment, consultation, ongoing coordination efforts and other assistance as needed. A “social service coordinator” is required to be a social worker certified in Wisconsin or have a minimum of a four-year bachelor’s degree in the human services area or a four-year bachelor’s degree in any other area with a minimum of three (3) years’ years experience in social service care management or related social service experience with persons in the MCO’s target population. Individuals holding a position comparable to a social service coordinator at the time an MCO first contracts to deliver a managed long-term care program in a new service area or to a new target population may be exempted from this requirement at the discretion of the Department. 2. The IDT staff shall have knowledge of community alternatives for the target populations served by the MCO and the full range of long-term care resources. IDT staff shall also have specialized knowledge of the conditions and functional limitations of the target populations served by the MCO, and of the individual members to whom they are assigned. The MCO shall establish a means that ensures ease of access and a reasonable level of responsiveness for each member to their IDT staff during regular business hours. 3. The Department recognizes that in the Partnership Program an MCO may encounter a shortage of available nurse practitioners. a. In order to make best use of the time of nurse practitioners while still assuring Partnership members have access to a nurse practitioner, an MCO may develop policies and procedures to apportion, in a way that is responsive to individual member needs, the time nurse practitioners work with the IDT of each individual member. Such policies and procedures may be guided by the needs of the population and could, under some circumstances use the time of a nurse practitioner solely to access prescriptions, provide triage services and as an educational resource for the IDT staff. All such policies and procedures will: i. Assure that every member’s IDT has some level of participation by a nurse practitioner; ii. Establish procedures for identifying the most appropriate level of participation by a nurse practitioner with the IDT of each individual member by taking into account the unique conditions and circumstances of the member; and iii. Assure that nurse practitioners are readily available to members who have the most need for advanced practice health care. b. On a case-by-case basis, basis the Department may approve a waiver to allow a Partnership MCO may choose to use a physician assistant or advanced practice nurse prescriber with experience working with the target groups and with demonstrated capacity to work independently to fulfill the need for advanced practice health care. This type of waiver request must demonstrate that the physician assistant or advanced practice nurse prescriber has experience working with the target groups and has demonstrated capacity to work independently. The MCO will continue to ensure request must also describe the strategy for assuring that the IDT of each member has access to an appropriate level of advanced practice health care.