1. Care Coordination Overview
Sandhills Center
2013

2. I/DD Care Coordination
Children and Adults on the
NC Innovations Waiver

3. NC Innovations Targeted Case Management
Targeted Case Management does not exist as a service in 1915 (b)(c) Managed Care Waivers
Care Coordination replaces many of the functions of Targeted Case Management
Care Coordination is a managed care administrative function
-Provided by the MCO/LME
Community Guide-delivered through private sector providers
(optional service/support)

4. NC Innovations Waiver Role of Care Coordinator
Educating participant/family/providers about services/supports, waiver requirements, eligibility, appeals/grievances, processes, other MH/SA/DD services and supports
Assessment of support needs (completing, arranging for, obtaining) ex: SIS, Level of Care determination
Linkage to needed psychological, behavioral, educational and physical evaluations
Complete Risk Assessment, Community Guide Need Survey

5. NC Innovations Waiver Role of Care Coordinator (cont.)
Linkage to needed MH/DD/SA resources (includes ensuring provider choice)
Facilitation of Planning/Development of Individual Support Plan (ISP)
Monitoring plan implementation, including health and safety
Coordination of Medicaid eligibility and benefits
Open communication with Community Guide as applicable

6. Questions ?

7. I/DD Care Coordination
Children and Adults not Enrolled in the NC Innovations Waiver

8. Care Coordination for Individuals Not Enrolled in the Innovations Waiver
I/DD consumers not enrolled in the Innovations program will receive care coordination.
Care Coordinator will:
Complete or arrange assessments to identify support needs
Develop Individual Support Plan
Monitor services

9. Questions ?

10. MH/SA Care Coordination
Children and Adults with Intensive Care Coordination Needs

11. Maximizing the Resources for High Risk/High Need Members
MH/SA Care Coordination will provide the following activities:
Ensure that eligible members receive the right amount of services at the right time
Ensure the development and implementation of a Person Centered Plan
Monitor the implementation of Person Centered Plans developed or revised to accommodate the needs of high risk members
Provide linkage to psychological, behavioral, educational, and physical evaluations and to service providers

12. Maximizing the Resources for High Risk/High Need Members
MH/SA Care Coordination will provide the following activities:
Coordination of Medicaid eligibility and benefits
Identify people with special healthcare needs
Provide education regarding available MH/DD/SA services
Ensure health and safety
Ensure that integrated care is part of a person’s healthcare needs
Assist in discharge planning
Make suggestions for enhancing a person’s care based on clinical guidelines adopted by the LME/MCO

13. Provider’s Responsibilities Regarding MH/SA Care Coordination
Providers are expected to:
Work collaboratively with the Care Coordinator
Provide information pertinent to the development of the PCP
Allow for routine evaluation of progress made on goals
Allow LME/MCO immediate access to member served
Allow LME/MCO staff to attend any discharge planning or treatment team meetings
Integrate behavioral health and physical health

14. Questions ?