VSHP BlueCare AMD Sample Clauses

VSHP BlueCare AMD. 15 (MCO 40197) Location: 0 Xxxxxxx Xxxx Circle Chattanooga, TN 37402 • Refined language throughout to more clearly reflect new CMS regulations • Added EVV requirement for Home Health Care Services and Personal Care Services in accordance with 21st Century Cures Act • Revise benefit language to reflect Chiropractic services covered for adults • Reduce EPSDT required coding education requirements to twice per year (from quarterly) • Add Health Starts program outline, amend P4P Health Starts program description and add Health Starts Initiative, Social Needs and Social Risk Factors • Add requirement to identify additional risk factors that require MCO to educate members and add Population Health Operational Details • Add Policy and Procedure requirement to BESMART audit • Added Credentialing language to require MCOs to comply with requirements when TennCare implements centralized data collection processes • Add requirement, at TennCare’s direction, MCO must develop and deliver parity‐based Utilization Management strategy for state‐identified high‐cost specialty drugs • Add requirement that MCOs implement additional pilots and programs related to delivery system transformation as defined by TennCare • Add intent to move Medicare Crossover payments to MCOs • Re‐start of the Money Follows the Person Demonstration starting July 1, 2022 (we had an extraordinarily successful MFP that ended in 2018 and CMS decided to re‐start the opportunity for states that had already expended prior funding) • Added Enabling Technology for CHOICES Groups 2 and 3 through March 31, 2024 (tied to ARP funds) • Increased expenditure/cost neutrality caps related to the ARP‐funded rate increases for CHOICES Group 3, ECF CHOICES Groups 4, 5, and 6 as well as the 1915(c) Self‐ Determination Waiver. This is not intended to allow for additional benefits, but instead to accommodate the rate increases to ensure individuals continue to have access to their currently approved HCBS • Included the Family Caregiver Supports Benefit available through ARP funding (through March 31, 2024) • Provided clarification related to the ECF CHOICES Group 7 Family Caregiver Support and ECF CHOICES Group 7 and 8 Member Outcome Surveys • Requires MCOs to ensure NFs are trained on redetermination in preparation for end of PHE • Changed reconciliation requirements for member employment (Employment Data Survey) from annually to quarterly • Changed Reportable Event Reports from quarterly to monthly • Updated and clarif...
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