Flexible Services certain services to address health-related social needs, for which expenditures are allowable for DSRIP reimbursement as described in Section 5.2.C.
Flexible Services certain services to address health-related social needs as described in Section 5.2.C and Appendix Y.
Flexible Services. In addition to Covered State Plan Services, Contractor shall include Flexible Services, in accordance with OAR 000-000-0000, that are consistent with achieving Member wellness and the objectives of an individualized care plan. Flexible Services must be coordinated by the Contractor, and may be in collaboration with the PCPCH or other PCP in the DSN. Flexible Services must be administered in accordance with Contractor’s policy, written in collaboration with XXX. Services covered under this Contract may be substituted with or expanded to include Flexible Services, in compliance with Contractor’s policy as written in collaboration with XXX, and agreed to by Contractor, the Member and, as appropriate, the family of the Member, as being an effective alternative. Contractor shall establish written policies and procedures, as written in collaboration with XXX for administering Flexible Services. The policies and procedures shall enable a Participating Provider to order and supervise the delivery of Flexible Services. Contractor shall submit these policies, as follows:
Flexible Services. Alternative services that are not included in the state plan or a waiver of the Arkansas Medicaid Program and that are appropriate and cost-effective services that improve the health or social determinants of a member of an enrollable Medicaid beneficiary population that affect the health of a member of an enrollable Medicaid beneficiary population.
Flexible Services. When delivering a Flexible Service (as opposed to using a Flexible Service Approach) and the Provider rendering a Flexible Service is not licensed or certified by a state board or licensing agency, or employs personnel to Provide the Service who do not meet the definition for Qualified Mental Health Associate (QMHA) or Qualified Mental Health Professional (QMHP) as described in Exhibit A, Definitions, Provider must meet criteria described in Exhibit B, Part II, Section 3, Credentialing Process, Subsection a.(1)(b).
Flexible Services. Enrollees that are enrolled in an ACO may be able to access Flexible Services as part of their ACO enrollment. Flexible Services are unique goods and services that are not otherwise covered under the Enrollee’s MassHealth benefit and which are provided to address a health-related social need. Flexible Services are authorized by an ACO through the Enrollee’s care plan. Governing Body – a board or other organized group of individuals, with the exclusive authority to make final decisions on behalf of the Contractor. Governance Structure - the corporate structure or affiliations, as described in Section 2.1, through which the Contractor will perform the requirements of the Contract. Grievance – any expression of dissatisfaction by an Assigned or Engaged Enrollee (or their authorized representative, if applicable), about any action or inaction by the Contractor. Possible subjects for Grievances include, but are not limited to, quality of supports provided, aspects of interpersonal relationships such as rudeness of an employee of the Contractor, or failure to respect the Assigned or Engaged Enrollee’s rights. Home and Community-Based Services (HCBS) Waiver – a federally approved program operated under Section 1915(c) of the Social Security Act that authorizes the U.S. Secretary of Health and Human Services to grant waivers of certain Medicaid statutory requirements so that a state may furnish home and community based services to certain Medicaid beneficiaries who require a level of care that is provided in a hospital, nursing facility, or Intermediate Care Facility for the Intellectually Disabled (ICF/ID). The ten HCBS Waivers are: the Frail Elder Waiver, the two ABI Waivers, the Traumatic Brain Injury Waiver, the four DDS Waivers and the two Money Follows the Person (MFP) Waivers. There are ten MassHealth HCBS Waivers: The Acquired Brain Injury Non-Residential waiver, the Acquired Brain Injury Residential Habilitation waiver, the Children’s Autism Spectrum Disorder waiver, the DDS Intensive Supports waiver, the DDS Community Living waiver, the DDS Adult Supports waiver, the Frail Elder waiver, the Money Follows the Person Community Living waiver, the Money Follows the Person Residential Supports waiver, and the Traumatic Brain Injury waiver. Identified Enrollee (Identification) – an Enrollee identified by EOHHS for Assignment to a Community Partner based on the Enrollee’s claims and service history or in another manner determined by EOHHS. Independent Living - ...
Flexible Services. As defined in Act 775, means alternative services that are not included in the state plan or a waiver of the Arkansas Medicaid Program and that are appropriate and cost-effective services that improve the health or social determinants of a member of an enrollable Medicaid beneficiary population that affect the health of the member of an enrollable Medicaid beneficiary population. These are outside of the benefit package that are delivered at the PASSE’s discretion. The cost of these services cannot be used in the development of capitation rates but may be reported as costs in the numerator of the plan’s MLR. Examples: additional non-medical transportation services not covered under Medicaid; supplemental Over-the-Counter (OTC) drugs or vitamins, nutritional assessment, home-delivered meals, services to “wrap around” an individual to enable successful discharge plan from a hospital to home; temporary supports to the family to avoid out- of-home placement; social activities to counter negative effects of isolation; providing a mobile phone or paying for a WIFI connection allows the PASSE to avoid residential or ICF placement by monitoring a member’s health and vitals remotely.
Flexible Services funds (flex funds) are available to support the open therapeutic community model on an immediate basis. Funding is accessed through flexible funds available to the CFT to cover the needs of the youth and family not covered by other sources of funding including but not limited to unanticipated costs associated with respite and crisis stabilization, transportation costs, housing assistance, furnishings, employment related services, and special medical costs not reimbursed by Medi-Cal.
Flexible Services funds (flex funds) are available to support the open therapeutic community model on an immediate basis. Funding is accessed through flexible funds available to the Child and Family Team while the child is enrolled in Wraparound to cover the needs of the youth and family not covered by other sources of funding including but not limited to unanticipated costs associated with respite and crisis stabilization, transportation costs, housing assistance, furnishings, employment related services, and special medical costs not reimbursed by MediCal. The Open Doors program design includes a proposed new RBS case rate of $10,194 per month for residential services. (See Section #14, Provider Cost Spreadsheet for Sections #2 and 3, at the end of this document for details concerning provider costs for all care.) A key facet of the new funding model is the full resourcing of frontloaded services to support the open therapeutic community model when a child is in residential services. One way to think about this new monthly case rate, is to compare it to a RCL 13 rate of $6,294 plus an additional $3,900 in reimbursement for additional services of the CFT, FFEPS and flexible funds. As shown on the Provider Cost Spreadsheet, this case rate is the average monthly cost per child to provide highly individualized services. Some children‟s individual costs may exceed this monthly average, others may fall below it. We have chosen the RCL 13 rate as an analogy because our partners are RCL 12 and 14 providers. Utilizing this new RBS case rate requires a waiver from the California Department of Social Services to replace the current RCL system with a new set of fiscal polices and regulations for the residential portion of the funding model, which they are authorized to grant under AB 1453, and which Los Angeles County has requested. . The Wraparound Tier 1 case rate was originally developed based on cost estimates and has been effect since 2006. In late 2007 DCFS and DMH collected actual expenditures data from all contracted Los Angeles Wraparound providers, and determined that the rate was consistent with average monthly allowable expenditures. The Wraparound Tier 2 case rate will be available beginning May 1, 2009, and is based on cost estimates developed by a Work group including providers. Table 1 below shows the Open Doors rate structure and the nominal length of stay anticipated for each component of service. The notes following the table detail the specifics of each type of ca...
