Care Coordination Overview

Sandhills Center2013

I/DD Care Coordination

Children and Adults on the NC Innovations Waiver

NC InnovationsTargeted Case Management

Targeted Case Management does not exist as a service in 1915 (b)(c) Managed Care Waivers

Care Coordination replaces many of the functions of Targeted Case Management

Care Coordination is a managed care administrative function

-Provided by the MCO/LME Community Guide-delivered through private

sector providers (optional service/support)

NC Innovations WaiverRole of Care Coordinator

Educating participant/family/providers about services/supports, waiver requirements, eligibility, appeals/grievances, processes, other MH/SA/DD services and supports

Assessment of support needs (completing, arranging for, obtaining) ex: SIS, Level of Care determination

Linkage to needed psychological, behavioral, educational and physical evaluations

Complete Risk Assessment, Community Guide Need Survey

NC Innovations Waiver Role of Care Coordinator

(cont.) Linkage to needed MH/DD/SA resources

(includes ensuring provider choice) Facilitation of Planning/Development of

Individual Support Plan (ISP) Monitoring plan implementation, including

health and safety Coordination of Medicaid eligibility and

benefits Open communication with Community Guide

as applicable

Questions ?

I/DD Care Coordination

Children and Adults not Enrolled in the NC Innovations

Waiver

Care Coordination for Individuals Not Enrolled in the Innovations

Waiver

I/DD consumers not enrolled in the Innovations program will receive care coordination.

Care Coordinator will: Complete or arrange assessments

to identify support needs Develop Individual Support Plan Monitor services

Questions ?

MH/SA Care Coordination

Children and Adults with Intensive Care Coordination

Needs

Maximizing the Resources for High Risk/High Need

Members MH/SA Care Coordination will provide the

following activities: Ensure that eligible members receive the right

amount of services at the right time Ensure the development and implementation

of a Person Centered Plan Monitor the implementation of Person

Centered Plans developed or revised to accommodate the needs of high risk members

Provide linkage to psychological, behavioral, educational, and physical evaluations and to service providers

Maximizing the Resources for High Risk/High Need

Members MH/SA Care Coordination will provide the following

activities: Coordination of Medicaid eligibility and benefits Identify people with special healthcare needs Provide education regarding available MH/DD/SA

services Ensure health and safety Ensure that integrated care is part of a person’s

healthcare needs Assist in discharge planning Make suggestions for enhancing a person’s care

based on clinical guidelines adopted by the LME/MCO

Provider’s Responsibilities Regarding MH/SA Care

Coordination

Providers are expected to: Work collaboratively with the Care Coordinator Provide information pertinent to the

development of the PCP Allow for routine evaluation of progress made

on goals Allow LME/MCO immediate access to member

served Allow LME/MCO staff to attend any discharge

planning or treatment team meetings Integrate behavioral health and physical

health

Questions ?