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TEAMKY Demonstration

Approval Period: January 1, 2025 through December 31, 2029

Page 24 of 155 31. Provider Network Capacity. Managed care plans must ensure the HRSN services authorized under the demonstration are provided to qualifying beneficiaries in a timely manner and shall develop policies and procedures outlining the managed care plan’s approach to managing provider shortages or other barriers to timely provision of the HRSN services, in accordance with the managed care plan contracts and other state Medicaid/operating agency guidance.

32. Compliance with Federal Requirements. The state shall ensure HRSN services are delivered in accordance with all applicable federal statutes and regulations.

33. Person Centered Service Plan. The state shall ensure there is a person-centered service plan for each beneficiary receiving HRSN services that is person-centered, identifies the beneficiary’s needs and individualized strategies and interventions for meeting those needs, and developed in consultation with the beneficiary and the beneficiary’s chosen support network, as appropriate. The service plan is reviewed and revised at least every 12 months, when the beneficiary’s circumstances or needs change significantly, or at the beneficiary’s request.

34. Conflict of Interest. The state shall ensure appropriate protections against conflicts of interest in HRSN service planning and delivery, including by ensuring that appropriate separation of service planning and service provision functions is incorporated into the state’s conflict of interest policies.

35. CMS Approval of Managed Care Contracts. As part of the state’s submission of associated Medicaid managed care plan contracts to implement HRSN service through managed care, the state must include contract requirements including, but not limited to :

a. Beneficiary and plan protections, including but not limited to:

i. HRSN services must not be used to reduce, discourage, or jeopardize beneficiaries’ access to covered services.

ii. Beneficiaries always retain their right to receive covered service on the same terms as would apply if HRSN services were not an option.

iii. Beneficiaries who are offered or utilized an HRSN service retain all rights and protections afforded under 42 CFR 438.

iv. Managed care plans are not permitted to deny a beneficiary a covered service on the basis that the beneficiary is currently receiving HRSN services, has requested those services, has previously qualified for or received those services, or currently qualifies or may qualify in the future for those services.

v. Managed care plans are prohibited from requiring a beneficiary to receive HRSN services.