MSSP PROGRAM OPERATIONS Clause Samples
MSSP PROGRAM OPERATIONS. The Contractor shall be responsible for all care management obligations including processing Waiver Participant applications, determining eligibility, conducting assessments, developing care plans, case recording and documentation, and providing follow-up. The Contractor shall directly provide or arrange for the continuous availability and accessibility of all services identified in each Waiver Participant’s care plan. The Contractor shall also ensure that the administrative integrity of the MSSP is maintained at all times. In order to maintain adequate administrative control, the Contractor shall incorporate the following components into the scope of operations:
MSSP PROGRAM OPERATIONS. (Continued)
6. Submit to CDA, by the 5th working day of the month (unless otherwise specified by CDA), the Wait List of Participants as of the last day of the previous month. “Wait List” means a list of potential MSSP Participants, established, and maintained by the Contractor, when the Contractor has reached its capacity. To ensure compliance with MSSP Waiver requirements and Centers for Medicare and Medicaid Services (CMS) direction, MSSP sites must develop and implement a wait list policy and procedure. The policy and procedure must include provisions for: prescreening individuals to determine eligibility; managing applicants’ placement on and removal from the wait list; periodically reviewing the eligibility and identified needs of applicants on the wait list; and assigning priority for enrollment based on identified needs and level of risk. The Contractor determines the priority of enrollment into the MSSP in accordance with CDA and CMS requirements.
MSSP PROGRAM OPERATIONS. (Continued)
3. The Contractor shall maintain written, signed and dated subcontracts for the following array of Purchased Waiver Services as defined in MSSP Site Manual at all times during the terms of this Agreement:
a) Adult Day Care (ADC)
b) Minor Home Repair/Maintenance Services
c) Supplemental Homemaker, Personal Care and Protective Supervision Services
d) Consultative Clinical Services e) Respite Care
MSSP PROGRAM OPERATIONS. (Continued)
MSSP PROGRAM OPERATIONS. (Continued)
2. The Contractor shall employ a care management team, which consists of a social worker and a registered nurse, that meet the qualifications set forth in the Waiver. The care management team shall determine waiver participant eligibility based on the criteria specified in the MSSP Site Manual, herein incorporated by reference. This team shall work with the waiver participant throughout the care management process (e.g., assessment, care plan development, service coordination, and service delivery).
3. The care management team shall: 1) provide information, education, counseling, and advocacy to the waiver participant and family, and 2) identify resources to help assure the timely, effective, and efficient mobilization and allocation of all services, regardless of the source, to meet the waiver participant’s care plan goals.
4. The Contractor shall annually self-certify that staff meet the requirements as outlined in the MSSP Site Manual as well as participate in required trainings.
B. Care Plan
1. The Contractor’s Care Management Team shall perform the MSSP waiver participant’s assessments and work with the MSSP waiver participant, family, managed care plans, and others to develop a care plan covering the full range of required psychosocial and health services. The Care Management Team shall continue to work with the MSSP waiver participant to assure that the waiver participant is receiving and benefiting from the services and to determine if modification of the care plan is required.
2. Such MSSP subcontracts shall specify terms and conditions and payment amount and shall assure that subcontractors shall not seek additional or outstanding unpaid amounts from the MSSP participant.
C. Purchased Waiver Services