Specifications include, but are not limited to: Provider agrees to provide the services listed below and only those services to consumers who are assigned by the Unified Government. Provider agrees all services will be performed exclusively by the Provider unless otherwise negotiated with Unified Government. FUNCTIONAL ELIGIBILITY ASSESSOR/CASE MANAGEMENT SERVICES Provider shall carry out all necessary functions related to the scope of the Functional Eligibility Assessor for Medicaid, Senior Care Act (SCA) and Older Americans Act (OAA) including, but not limited to, the four components defined as follows: 1. Assessment/Reassessment Assessment provides a detailed review of a consumer’s functioning and a database from which to design an appropriate service Plan of Care. Assessment/Reassessment includes a comprehensive review of consumer’s medical needs, social needs, psychological needs, functional capabilities, and current services received through formal and informal sources. Provider must complete the initial assessment within five working days from the date of referral. Reassessment is the periodic review of the assessment data which shall be conducted when needed, but at least annually, to determine changes in the consumer’s overall condition and circumstances and to evaluate the continued appropriateness of the service Plan of Care. 2. Development of a Plan of Care The development of a Plan of Care forms an individualized agreement between the consumer, or his or her legal representative, and the Provider. The Plan of Care utilizes assessment data to identify needs, goals, and preferences of the consumer within cost restraints, for a set period of time. The Plan of Care should identify outcomes to be achieved, services to be pursued, and how these outcomes and services will support the achievement of the consumer’s goals. Implementation of the service Plan of Care requires the Provider to initiate contacts and/or conferences with the consumer and/or his or her legal representative, service providers, and others as agreed to by the consumer. The purpose will be to arrange for an effective and efficient continuum of informal and formal service by determining availability and costs of needed services. The Provider must also coordinate the provision of services with the consumer, formal and informal service providers, and other agencies in order to implement the Plan of Care in an efficient manner. 3. Monitoring and Follow-up Activities The Provider will visit with the consumer at least every 60 to 90 days, or more often if individual need requires, and will confer with other providers as needed to assure that the services being provided are appropriate, of good quality, provided in sufficient amount, and with efficient coordination so as to continually meet the needs, preferences, and goals of the consumer within the service Plan of Care. Case Management requires a commitment to the efficient use of public and private resources to meet consumer needs and preferences. Monitoring and follow-up activities involves at a minimum: (1) Determining the comparative costs of alternative care plans options; (2) The services in the care plan are adequate; (3) Monitoring service expenditures over time; and (4) Advocating for the consumer in accessing the provider preference and delivery system.
