Care Coordination Overview

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Presentation transcript:

Care Coordination Overview Sandhills Center 2013

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

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)

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

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

Questions ?

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

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

Questions ?

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

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

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

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

Questions ?