Common use of Transition Plan for New STAR Clause in Contracts

Transition Plan for New STAR. +PLUS Members 1. review of existing Long-Term Services and Supports plans prepared by DADS or another STAR+PLUS MCO; 2. preparation of a transition plan that ensures continuous care under the Member’s existing Care Plan during the transfer into the MCO’s Network while the MCO conducts an appropriate assessment and development of a new plan, if needed; 3. if durable medical equipment or supplies had been ordered prior to enrollment but have not been received by the time of enrollment, coordination and follow-through to ensure that the Member receives the necessary supportive equipment and supplies without undue delay; and 4. payment to the existing provider of service under the existing authorization for up to six (6) months, until the MCO has completed the assessment and Service Plans and issued new authorizations. Except as provided below, the MCO must review any existing care plan and develop a transition plan within 30 days of receiving notice of the Member’s enrollment. For all existing care plans received prior to the Operational Start Date, the MCO will have additional time to complete this process, not-to-exceed 120 days after the Member’s enrollment. The transition plan will remain in place until the MCO contacts the Member or the Member’s representative and coordinates modifications to the Member’s current treatment/Long-Term Services and Supports plan. The MCO must ensure that the existing services continue and that there are no breaks in services. For initial implementation of the STAR+PLUS program in a Service Area, the MCO must honor existing LTSS authorizations for up to six (6) months following the Operational Start Date, or until the MCO has evaluated and assessed the Member and issued new authorizations. The Service Plan includes, but is not limited to, the following: 1. the Member’s history; 2. summary of current medical and social needs and concerns; 3. short and long term needs and goals; 4. a list of services required, their frequency, and 5. a description of who will provide such services. The Service Plan may include information for services outside the scope of covered benefits such as how to access affordable, integrated housing. The MCO must ensure that the Member or the Member’s representative is involved in the assessment process and fully informed about options, is included in the development of the Service Plan, and is in agreement with the plan when completed.

Transition Plan for New STAR. +PLUS Members 1. review of existing Long-Term Services and Supports plans prepared by DADS or another STAR+PLUS MCO; 2. preparation of a transition plan that ensures continuous care under the Member’s existing Care Plan during the transfer into the MCO’s Network while the MCO conducts an appropriate assessment and development of a new plan, if needed; 3. if durable medical equipment or supplies had been ordered prior to enrollment but have not been received by the time of enrollment, coordination and follow-through to ensure that the Member receives the necessary supportive equipment and supplies without undue delay; and 4. payment to the existing provider of service under the existing authorization for up to six (6) months, until the MCO has completed the assessment and Service Plans and issued new authorizations. Except as provided below, the MCO must review any existing care plan and develop a transition plan within 30 days of receiving notice of the Member’s enrollment. For all existing care plans received prior to the Operational Start Date, the MCO will have additional time to complete this process, not-to-exceed 120 days after the Member’s enrollment. The transition plan will remain in place until the MCO contacts the Member or the Member’s representative and coordinates modifications to the Member’s current treatment/Long-Term Services and Supports plan. The MCO must ensure that the existing services continue and that there are no breaks in services. For initial implementation of the STAR+PLUS program in a Service Area, the MCO must honor existing LTSS authorizations for up to six (6) months following the Operational Start Date, or until the MCO has evaluated and assessed the Member and issued new authorizations. The Service Plan includes, but is not limited to, the following: 1. the Member’s history; 2. summary of current medical and social needs and concerns; 3. short and long term needs and goals; 4. a list of services required, their frequency, and 5. a description of who will provide such services. The Service Plan may include information for services outside the scope of covered benefits such as how to access affordable, integrated housing. The MCO must ensure that the Member or the Member’s representative is involved in the assessment process and fully informed about options, is included in the development of the Service Plan, and is in agreement with the plan when completed.

Transition Plan for New STAR. +PLUS Members 1. review of existing LongDADS long-Term Services and Supports plans prepared by DADS or another STAR+PLUS MCOterm care services plans; 2. preparation of a transition plan that ensures continuous care under the Member’s existing Care Plan during the transfer into the MCOHMO’s Network while the MCO HMO conducts an appropriate assessment and development of a new plan, if needed; 3. if durable medical equipment or supplies had been ordered prior to enrollment but have not been received by the time of enrollment, coordination and follow-through to ensure that the Member receives the necessary supportive equipment and supplies without undue delay; and 4. payment to the existing provider of service under the existing authorization for up to six (6) months, until the MCO HMO has completed the assessment and Service Plans service plans and issued new authorizations. Except as provided below, the MCO HMO must review any existing care plan and develop a transition plan within 30 days of receiving notice of the Member’s enrollment. For all existing care plans received prior to the Operational Start Date, the MCO HMO will have additional time to complete this process, not-to-exceed 120 days after the Member’s enrollment. The transition plan will remain in place until the MCO HMO contacts the Member or the Member’s representative and coordinates modifications to the Member’s current treatment/Longlong-Term Services and Supports term care services plan. The MCO HMO must ensure that the existing services continue and that there are no breaks in services. For initial implementation of the STAR+PLUS program in a Service Area, the MCO HMO must honor complete this process within 90-days of the Member’s enrollment. The HMO must review any existing LTSS authorizations for up to six (6) months following care plan and develop a transition plan within 30 days of receiving the Operational Start Date, or Member’s enrollment. The transition plan will remain in place until the MCO has evaluated and assessed HMO contacts the Member and issued new authorizations. The Service Plan includes, but is not limited to, the following: 1. coordinates modifications to the Member’s history; 2current treatment/long-term care services plan. summary of current medical The HMO must ensure that the existing services continue and social needs and concerns; 3. short and long term needs and goals; 4. a list of services required, their frequency, and 5. a description of who will provide such that there are no breaks in services. The For initial implementation of the STAR+PLUS program in a Service Plan may include information for services outside Area, the scope HMO must complete this process within 90-days of covered benefits such as how to access affordable, integrated housingthe Member’s enrollment. The MCO HMO must ensure that the Member or the Member’s representative is involved in the assessment process and fully informed about options, is included in the development of the Service Plancare plan, and is in agreement with the plan when completed.