Common use of Policies and Procedures Regarding Member Safety and Risk Clause in Contracts

Policies and Procedures Regarding Member Safety and Risk. The MCO shall have policies and procedures in place regarding member safety and risk, which shall be submitted to the Department for approval prior to implementation, whenever a change occurs, and upon request. MCO staff and other appropriate individuals shall be informed of these policies on an ongoing basis. The purpose of these policies and procedures is to balance member needs for safety, protection, good physical health and freedom from accidents, with over-all quality of life and individual choice and freedom. These policies and procedures shall identify: How IDT staff will assess and respond to risk factors affecting members’ health and safety; Guidelines for use by IDT staff in balancing member rights with member safety through a process of ongoing negotiation and joint problem solving; Criteria for use by IDT staff to identify risk, including vulnerable/high risk members as defined in Article I.139; Training for all IDT staff in identifying risk and coordinating care; Guidelines and tools to assist IDT staff in identifying and mitigating risk; and Protocols for use by IDT staff to identify, implement and document appropriate, individualized monitoring and safeguards to address and mitigate potential concerns and assure the health and safety of all members including those identified as vulnerable/high risk as defined in Article I.139. At a minimum these protocols must include:

Policies and Procedures Regarding Member Safety and Risk. The MCO shall have policies and procedures in place regarding member safety and risk, which shall be submitted to the Department for approval prior to implementation, whenever a change occurs, and upon request. MCO staff and other appropriate individuals shall be informed of these policies on an ongoing basis. The purpose of these policies and procedures is to balance member needs for safety, protection, good physical health and freedom from accidents, with over-all quality of life and individual choice and freedom. These policies and procedures shall identify: How IDT staff will assess and respond to risk factors affecting members’ health and safety; Guidelines for use by IDT staff in balancing member rights with member safety through a process of ongoing negotiation and joint problem solving; Criteria for use by IDT staff to identify risk, including vulnerable/high risk members as defined in Article I.139I.143; Training for all IDT staff in identifying risk and coordinating care; Guidelines Guidelines, trainings, and tools to assist IDT staff in identifying and mitigating riskrisk with all members and/or their legal decision maker; Training and guidance for all IDT staff that identified concerns and risks that require mitigation, but a member chooses not to prioritize is reviewed with the member at least every three months, and documented in the members record as identified in the MCP; Protocols for use by IDT staff to identify, implement and document appropriate, individualized monitoring and safeguards to address and mitigate potential concerns and assure the health and safety of all members including those identified as vulnerable/high risk as defined in Article I.139. At a minimum these protocols must include: