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<br /> <br /> Page 40 of 48 <br />17.9 Care Management for At-Risk Children: Training. Participating Provider shall participate in NC <br />DHHS/ WellCare-sponsored webinars, trainings and continuing education opportunities as provided. Participating <br />Provider shall pursue ongoing continuing education opportunities to stay current in evidence-based care management <br />of high risk children. <br /> <br />17.10 Care Management for At-Risk Children: Staffing. <br /> <br />(a) Participating Provider shall hire care managers meeting Care Management for At-Risk <br />Children care coordination competencies and with at least one of the following qualifications: registered nurse; or <br />social worker with a bachelor’s degree in social work (BSW, BA in SW, or BS in SW) or master’s degre e in social <br />work (MSW, MA in SW, or MS in SW) from a Council on Social Work Education accredited social work degree <br />program. Non-degreed social workers cannot be the lead care manager providing Care Management for At -Risk <br />Children even if they qualify as a Social Worker under the Office of State Personnel guidelines. Participating <br />Provider shall engage care managers who operate with a high level of professionalism and possess an appropriate <br />mix of skills needed to work effectively with high-risk children. This skill mix must reflect the capacity to address <br />the needs of patients with both medically and socially complex conditions. Participating Provider shall ensure that <br />the team of Care Management for At-Risk Children care managers shall include both registered nurses and social <br />workers to best meet the needs of the target population with medical and psychosocial risk factors. If the Participating <br />Provider has only has a single Care Management for At-Risk Children care manager, the Participating Provider shall <br />ensure access to individual(s) to provide needed resources, consultation and guidance from the non -represented <br />professional discipline. Participating Provider shall maintain services during the event of an extended vacancy. In <br />the event of an extended vacancy, Participating Provider shall complete and submit the vacancy contingency plan <br />that describes how an extended staffing vacancy will be covered and the plan for hiring if applicable. Participating <br />Provider shall establish staffing arrangements to ensure continuous service delivery through appropriate management <br />of staff vacancies and extended absences, including following NC DHHS guidance regarding vacancies or extended <br />staff absences and adhering to NC DHHS guidance about contingency planning t o prevent interruptions in service <br />delivery. Vacancies lasting longer than sixty (60) days will be subject to additional oversight. Participating Provider <br />shall ensure that supervisors who carry a caseload must also meet the Care Management for At -Risk Children care <br />management competencies and staffing qualifications. Participating Provider shall ensure that Community Health <br />Workers and other unlicensed staff work under the supervision and direction of a trained Care Management for At - <br />Risk Children Care Manager. <br /> <br />(b) Participating Provider shall ensure that Care Management for At -Risk Children Care <br />Managers must demonstrate: (i) proficiency with the technologies required to perform care management functions – <br />particularly as pertains to claims data review and care management documentation system; (ii) ability to effectively <br />communicate with families and providers; (iii) critical thinking skills, clinical judgment and problem -solving <br />abilities; and (iv) motivational interviewing skills, Trauma Informed Care, and knowledge of adult teaching and <br />learning principles. <br /> <br />(c) Participating Provider shall provide qualified supervision and support for Care Management <br />for At-Risk Children care managers to ensure that all activities are designed to meet performance measures , with <br />supervision to include: (i) provision of program updates to care managers; (ii) daily availability for case consultation <br />and caseload oversight; (iii) regular meetings with direct service care management staff; and (iv) utilization of <br />monthly and on-demand reports to actively assess individual care manager performance. <br /> <br />18. N.C. Gen. Stat. Ch. 58 Requirements. <br /> <br />18.1 N.C. Gen. Stat. § 58-3-200(c), Coverage Determinations. If WellCare or Payor determines that <br />services, supplies or other items are Covered Services, WellCare or Payor shall not subsequently retract its <br />determination after such services have been provided, or reduce payments for such services furnished in reliance on <br />such a determination, unless the determination was based on a material misrepresentation about the Covered Person’s <br />health condition that was knowingly made by the Covered Person or the provider of the service, supply or other item. <br />(Section VII, G (1)(x)(i)). <br />DocuSign Envelope ID: 2EC1F0FD-FAF9-4B42-B52E-D419F55A6210