Chapter 19A of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting, after section 4, the following section:-
Section 4 1/2.
(a) For the purposes of this section, the following words shall have the following meanings: “Clinically Complex”. A summarized status of an individual’s clinical eligibility for receiving intensive case management.
(b) There is hereby established the intensive case management program for the purposes of supporting individuals who are current or prospective participants of the home care program established in section 4, but who are determined to be clinically complex and therefore require sustained, in-depth case management exceeding the level provided under the program. Intensive case management shall be provided to transition an individual into receiving home care program services, or to retain an active enrollee who is experiencing program participation challenges due to 1) serious mental illness or behavioral disturbances; 2) complex dynamics involving the family and informal support networks that impact the acceptance or delivery of critical home care services; or 3) multiple medical and/or functional needs that put at risk the ability of the ASAP to appropriately serve the enrollee.
(c) The department shall establish intensive case management reimbursement rates that reasonably reflect the level of expertise and commitment of time required to successfully support a qualifying individual’s enrollment and ongoing participation in the State Home Care program.
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