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Care Coordination Overview

Care Coordination Overview

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Care Coordination Overview

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  1. Care Coordination Overview Sandhills Center 2013

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

  3. NC InnovationsTargeted 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 WaiverRole 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 ?