Orange County NC Website
Browse       Search
<br /> <br /> Page 39 of 48 <br />17.3 Care Management for At-Risk Children: Population Identification. Participating Provider shall use <br />any claims-based reports and other information provided by WellCare, as well as Care Management for At-Risk <br />Children Referral Forms received to identify priority populations. Participating Provider shall establish and maintain <br />contact with referral sources to assist in methods of identification and referral for the target population. Participating <br />Provider shall communicate with the medical home and other primary care clinician about the Care Management for <br />At-Risk Children target group and how to refer to the Care Management for At-Risk Children program. <br /> <br />17.4 Care Management for At-Risk Children: Family Engagement. Participating Provider shall involve <br />families (or legal guardian when appropriate) in the decision-making process through a patient-centered, collaborative <br />partnership approach to assist with improved self-care. Participating Provider shall foster self-management skill <br />building when working with families of children. Participating Provider shall prioritize face-to-face family <br />interactions (home visit, PCP office visit, hospital visit, community visit, etc.) over telephone interactions for children <br />in active case status, when possible. <br /> <br />17.5 Care Management for At-Risk Children: Assessment and Stratification of Care Management Service <br />Level. Participating Provider shall use the information gathered during the assessment process to determine whether <br />the child meets the Care Management for At-Risk Children target population description. Participating Provider shall <br />review and monitor WellCare reports created for Care Management for At-Risk Children, along with the information <br />obtained from the family, to assure the child is appropriately linked to preventive and primary care services and to <br />identify individuals at risk. Participating Provider shall use the information gained from the assessment to determine <br />the need for and the level of service to be provided. <br /> <br />17.6 Care Management for At-Risk Children: Plan of Care. Participating Provider shall provide <br />information and/or education to meet families’ needs and encourage self-management using materials that meet <br />literacy standards. Participating Provider shall ensure children/families are well -linked to the child’s Advanced <br />Medical Home or other practice; provide education about the importance of the medical home. Participating Provider <br />shall provide care management services in accordance with program guidelines, including condition -specific <br />pathways, utilizing those interventions that are most effective in engaging patients, meeting their needs and achieving <br />care plan goals. Participating Provider shall identify and coordinate care with community agencies/resources to meet <br />the specific needs of the child; use any locally-developed resource list (including NC Resource Platform) to ensure <br />families are well linked to resources to meet the identified need. Participating Provider shall provide care <br />management services based upon the patient’s level of need as determined through ongoing assessment. <br /> <br />17.7 Care Management for At-Risk Children: Integration with WellCare and Providers. Participating <br />Provider shall collaborate with Advanced Medical Home/PCP/care team to facilitate implementation of patient - <br />centered plans and goals targeted to meet individual child’s needs. Participating Provider shall ensure that changes <br />in the care management level of care, need for patient support and follow up and other relevant updates (especially <br />during periods of transition) are communicated to the Advanced Medical Home PCP and/or care team. Wh ere care <br />management is being provided by WellCare and/or Advanced Medical Home practice in addition to the Care <br />Management for At-Risk program, the WellCare/AMH practice must explicitly agree on the delineation of <br />responsibility and document that agreement in the child’s Plan of Care to avoid duplication of services Participating <br />Provider shall ensure that changes in the care management level of care, need for patient support and follow up and <br />other relevant updates (especially during periods of transition) are communicated to the Advanced Medical home <br />PCP and/or care team and to WellCare. Participating Provider shall ensure awareness of WellCare Covered Person’s <br />“in network” status with providers when organizing referrals. Participating Provider shall en sure understanding of <br />WellCare’s prior authorization processes relevant to referrals. <br /> <br />17.8 Care Management for At-Risk Children: Service Provision. Participating Provider shall document <br />all care management activities in the care management documentation syst em in a timely manner. Participating <br />Provider shall ensure that the services provided by Care Management for At -Risk Children meet a specific need of <br />the family and work collaboratively with the family and other service providers to ensure the services ar e provided <br />as a coordinated effort that does not duplicate services. <br /> <br />DocuSign Envelope ID: 2EC1F0FD-FAF9-4B42-B52E-D419F55A6210