Section 360-11.6 Requirements for a managed care plan in an MCP that includes special
care furnished on more than an incidental basis.
(a) A managed care plan that includes the provision of special care to
participants in an MCP who require special care furnished on more than an incidental basis
must specify the process under which such MCP participants will be provided with managed
special care providers so that special care can be obtained. The responsibilities of the
social services district, the managed care providers, the local mental hygiene director
and any designee of an RSCA must be described in the special care provisions of the
managed care plan.
(b) The special care provisions of a managed care plan must be
developed in coordination with the managed care providers participating in the MCP, the
local mental hygiene director, the community services board and any designee of an RSCA.
(c) The special care provisions of a managed care plan must:
(1) include the participation of persons who
are recipients of SSI;
(2) include the long term special care services
for persons with chronic illness defined in subdivision (c) of section 360-11.3 of this
Subpart;
(3) identify a provider network adequate to
meet the needs of participants who require special care;
(4) require coordinated treatment planning to
integrate the health and special care needs of participants receiving special care from
providers other than the managed care providers, including identification of the process
and time intervals for periodic coordinated review by managed care and managed special
care providers of treatment plans and participant progress under these plans;
(5) include a procedure for special care
providers to obtain authorization for continued furnishing of special care;
(6) include a procedure for rapid re-entry into
special care of participants who relapse or have crises associated with chronic special
care needs;
(7) require formal agreements that satisfy the
requirements of paragraphs (4), (5) and (6) of this subdivision between managed care
providers and special care providers; and (8) include provisions for training managed care
and managed special care staff to assure identification and treatment of participants
requiring integrated health services and special care.