The Clinical Advice and Support Line shall be incorporated in the policies and Contractor’s procedures for care coordination and Care Management, such as policies and procedures for: The Clinical Advice and Support Line notifying Providers and Care Management staff involved in an care of a phone call, Enrollee’s particularly if the call indicates a need to modify the documented Care Plan or Enrollee’s course of treatment or a need for follow-up; The Clinical Advice and Support Line’s clinicians being able to access relevant information from an Care Plan or Enrollee’s medical record under certain circumstances to respond to an questions and Enrollee’s coordinate care; and The Clinical Advice and Support Line providing appropriate information and navigation to Enrollees to Providers who can support an needs, including but not Enrollee’s limited to Network Providers and providers involved in an care; Enrollee’s The Clinical Advice and Support Line shall otherwise coordinate with an PCP, Care Enrollee’s Coordinator, or Clinical Care Manager, as applicable, including through providing “warm to such individuals through direct transfer handoffs” protocols and processes and capabilities to share information with such individuals; Provide general health information to Enrollees and answer general health and wellness-related questions; Comprehensive Assessment and Member-Centered Care Planning The Contractor shall ensure that certain Enrollees, as described in this Section and further specified by EOHHS, receive a Comprehensive Assessment that informs a documented Care Plan. Such Comprehensive Assessment and documented Care Plan shall be member-centered and shall inform care, including but not limited to any Care Enrollees’ Management activities, as described in this Section and further specified by EOHHS. The Contractor shall provide certain Enrollees with Comprehensive Assessments as follows:
The Clinical Advice and Support Line shall be incorporated in the Contractor’s policies and procedures for care coordination and Care Management, such as policies and procedures for: The Clinical Advice and Support Line notifying Providers and Care Management staff involved in an Enrollee’s care of a phone call, particularly if the call indicates a need to modify the Enrollee’s documented Care Plan or course of treatment or a need for follow-up; The Clinical Advice and Support Line’s clinicians being able to access relevant information from an Enrollee’s Care Plan or medical record under certain circumstances to respond to an Enrollee’s questions and coordinate care; and The Clinical Advice and Support Line providing appropriate information and navigation to Enrollees to Providers who can support an Enrollee’s needs, including but not limited to Network Providers and providers involved in an Enrollee’s care; The Clinical Advice and Support Line shall otherwise coordinate with an Enrollee’s PCP, Care Coordinator, or Clinical Care Manager, as applicable, including through providing “warm handoffs” to such individuals through direct transfer protocols and processes and capabilities to share information with such individuals; Provide general health information to Enrollees and answer general health and wellness-related questions; Comprehensive Assessment and Member-Centered Care Planning The Contractor shall ensure that certain Enrollees, as described in this Section and further specified by EOHHS, receive a Comprehensive Assessment that informs a documented Care Plan. Such Comprehensive Assessment and documented Care Plan shall be member-centered and shall inform Enrollees’ care, including but not limited to any Care Management activities, as described in this Section and further specified by EOHHS. The Contractor shall provide certain Enrollees with Comprehensive Assessments as follows:
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