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Transparency and Provider Support Kentucky DMS will maintain a central repository of information about documentation requirements and KHIE participation on its official website. This resource will include detailed guidelines for providers, technical support for KHIE integration, and updates on program expectations. By fostering transparency and providing clear resources, DMS ensures that providers are well-equipped to meet the documentation and data exchange standards of the Recuperative Care Pilot. Through meticulous record-keeping and secure data exchange, DMS’s integration of KHIE into the Recuperative Care Pilot enhances the efficiency, quality, and continuity of care for Medicaid members. This initiative underscores Kentucky’s commitment to leveraging technology and innovation to improve health outcomes for its most vulnerable populations. This structured approach ensures that HRSN care plans remain dynamic and responsive to each individual’s needs, maximizing the potential for successful outcomes. Care Plan Review: weekly review of patient’s plan of care by Recuperative Care Pilot care team. Integration with Kentucky’s kynect resources The inclusion of Kentucky’s kynect resources platform enhances the care planning process by providing members with access to a broad network of local programs and services. The platform’s Eligibility Assessment helps care teams identify and prioritize SDOH-related needs, ensuring that referrals to housing support, food pantries, and transportation assistance are tailored to the member’s circumstances. This integration allows care plans to address not only medical issues but also the social barriers that impact health outcomes. Ongoing Review and Adaptation The care coordination plan is designed to be dynamic, with ongoing reviews conducted weekly or as needed to reflect changes in the member’s condition. Adjustments are made to ensure the plan continues to meet the member’s evolving needs, such as changes in medical status, behavioral health priorities, or access to resources.