Frequency of Assessments Clause Samples

Frequency of Assessments. At Enrollment The Contractor shall complete a Comprehensive Assessment within thirty (30) calendar days of each Enrollee’s Effective Enrollment Date. The Contractor shall make subsequent attempts beyond the thirty (30) days if the initial attempt to contact the Enrollee is unsuccessful. The Contractor shall incorporate the following into their policies and procedures for unreachable Enrollees: The Contractor shall submit a weekly no contact list to EOHHS outlining frequency and type of outreach efforts, The Contractor’s Medical Director or designee shall review past and/or current claims utilization to find provider(s) and/or pharmacies connected to the Enrollee, and The Contractor shall notify EOHHS of Enrollees who remain unreachable after 180 days, have not actively participated in Care Coordination, Assessment and Care Planning, and who have no claims for physical and/or behavioral health treatment. With the Member’s consent, the Contractor may complete the assessment in advance of the Effective Enrollment Date for new SCO program Enrollees. For Enrollees participating in the Frail Elder Waiver, the assessment at the time of enrollment is completed by an ASAP RN. The Contractor is not required to conduct a new Comprehensive Assessment for individuals who were enrolled in the Contractor’s SCO Plan prior to January 1, 2026, and for whom that Comprehensive Assessment is still current. Ongoing The Contractor shall complete Comprehensive Assessments for all Enrollees to identify all of an Enrollee’s needs, and to evaluate and identify Complex Care needs: For all Enrollees, at least once every six months; At least quarterly for Enrollees who require Complex Care; More frequently when indicated by the condition identified; or Whenever an Enrollee experiences a major change that is: Not temporary or episodic; Impacts more than one area of health status; and Requires interdisciplinary review or revision of the Individualized Care Plan. Approach

Frequency of Assessments. The Contractor must: a. Record the results of all assessments in the Centralized Enrollee Record and communicate the results to the Enrollee’s Provider Network in a timely manner; and b. Perform Ongoing Assessments of each Enrollee’s needs: 1) At least once every six months, or 2) For Enrollees who require Complex Care, at least quarterly and performed by a member of the Enrollee’s PCT, or 3) Whenever an Enrollee experiences a major change that is: a) Not temporary; b) Impacts more than one area of health status; and c) Requires interdisciplinary review or revision of the Individualized Plan of Care. 4) The Contractor shall have a process in place to verify Enrollee receipt of services for which Providers have billed the Contractor. This verification of covered services shall be documented in the Centralized Enrollee Record in accordance with Section 2.4.A.8.m.

Frequency of Assessments