XVII. Face-to-Face Care Management Contact Requirements

FTF requirements outlined below will reference in-person or remote care management service delivery. FTF contacts can occur in two possible ways: 1) in-person; or 2) through the use of remote technology where those in the meeting can be seen via the use of video technology and heard via the use of audio technology. The remainder of this policy will refer to these two options as “In-Person” and “Remote” contacts. Policy information defining the use of Remote Technology to meet the Care Management FTF contact requirements can be found below.

In-person FTF requirements are considered the minimum number of contacts to support billing for CCO/HH services.  It is expected that Care Managers will provide care management services and supports based on the specific needs and method(s) of interaction needed for each enrollee’s unique circumstances taking into account relevant factors such as the person’s preferred communication style; use of verbal/non-verbal communication methods; cultural and linguistic needs of the person and their family members or advocates; availability of technology to communicate; living situation; need for health and safety checks; major life changes that happen in a person’s life; and other relevant factors.  

The Care Manager is expected to establish and maintain a trusting and supportive relationship with each enrollee that maximizes the benefits and goals of the care management service and to address the enrollee’s needs and desired outcomes. For example, more frequent FTF contacts are especially important when a person is new to the care management service or has a new Care Manager to help establish a trusting and supportive relationship. It should not be assumed that the required minimum number of In-Person and/or Remote contacts equates to the provision of quality care management services. The expectation is that the Care Manager will evaluate, monitor, and adjust the number and type of meetings that will best meet the person’s needs and goals as needed.

In addition, Care Managers must meet with someone In-Person immediately if there is cause to do so. This could be due to any potential health or safety risk, or concerns relayed to the Care Manager by the person, family members, advocates, providers, or another party. Also, if the person’s needs warrant an In-Person health and safety check, an In-Person contact must occur (Examples include: the home environment poses a risk to the person; the person is not keeping their home clean and sanitary; the person has no weather appropriate clothing or food; there is no natural supports or paid service providers that interact with the person on a regular basis).

The following chart outlines the minimum requirements for FTF care management contacts that must occur at each Tier, in accordance with applicable OPWDD and NYSDOH guidance and the provisions of this policy.

• This chart references a calendar year, and the required contacts should be prorated, beginning with the first full quarter of enrollment, based on these triggering events: End of Public Health Emergency (PHE), enrollment or disenrollment, or if the person moves between tiers or service types within the calendar year.
• For all new CCO/HH enrollees, regardless of tier, within sixty (60) days of enrollment into a CCO/HH, the Care Manager must conduct an In-Person meeting with the person.  

* The year is a 12-month calendar year and necessary contacts are prorated due to enrollment or disenrollment or if the person moves tiers within the calendar year. 

Remote Technology, for the purposes of this policy, refers to an electronic method of care management service delivery, including any two-way, real-time communication which incorporates audio and video components and that meets the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) including all applicable telehealth and/or remote security standards. Remote Technology is a permissible option to meet the Care Management FTF contact requirements when all the following are true:

1. The request to use remote technology is initiated by the enrollee and/or their family/representative and not the CCO or care manager.
2. The remote support is face-to-face (i.e., the Care Manager can see the enrollee/enrollee’s representative and the enrollee can see the Care Manager and Care Planning Team)
3. The remote supports ensure the enrollee’s rights of privacy, dignity, and respect, and freedom from coercion restraint.

Remote technology cannot be the sole mode of care management FTF contact with an enrollee (see the requirements outlined in Table 1 up above). Remote technology is available under certain conditions to allow for continuity of care management services when in-person care management contact is not possible (e.g., during recovery from an accident, illness, crisis), or it may be used as part of care management service delivery that incorporates both In-Person contact and Remote contact in order to provide greater flexibility to the enrollee and/or their family/representative when desired, appropriate and effective to the delivery of care management services.

The Care Manager and care planning team must assess the effectiveness of care management contacts during times when remote care management contacts are provided to the enrollee and assess that the enrollee’s needs can be effectively met when remote technology is used. People may require some physical assistance from natural or paid supports to set up and facilitate the contact/visit/meeting. If the enrollee lives in a certified residential setting, the Residential Habilitation provider must participate in the person-centered planning process regarding the delivery of Remote care management contacts. If the enrollee’s needs cannot be met and the enrollee's privacy cannot be assured, then the delivery of care management services using remote technology is not appropriate or acceptable. The Care Management record must document that this process occurred.

The appropriate use of remote technology for care management and other specific services (see ADM#2021-03 Ability to use Technology to Remotely Deliver Home and Community-Based Services (HCBS)) is determined as part of the person-centered planning process. People must affirmatively request Remote care management contacts over In-Person contacts and provide written informed consent for the delivery of care management services via remote technology. The planning team will establish an agreed upon schedule for In-Person and Remote care management contacts, and the Care Manager must document the enrollees decision to use Remote contacts and confirm effective delivery of care management services via Remote contacts.

The enrollee and/or the family/representative and the Care Manager each have a role in planning for the use of remote technology as described below.

Role of the enrollee and/or the family/representative:

1. The enrollee and/or the family/representative must provide informed consent to receive Remote care management contact(s) in lieu of the required In-Person contact(s) as outlined in the chart below.
2. The enrollee and/or the family/representative must reaffirm their choice to continue engaging in Remote contacts during each Life Plan review (semi-annually).
3. The enrollee and/or the family/representative will contact the Care Manager, at any time, if the use of remote technology is no longer desired

Role of the CCO Care Manager Delivering the Face-to-Face Remote Service:

1. The Care Manager explains privacy requirements and appropriately documents in the enrollee’s Life Plan that the enrollee and/or the family/representative have expressed a desire and have consented to engage in Remote care management contacts.
2. The Care Manager must confirm that the enrollee has the equipment adequately suited to the enrollee’s needs to appropriately engage in Remote care management contact. The equipment must meet all security standards set forth in HIPAA. The equipment must also include both audio and visual modalities.
3. The Care Manager attests they have informed the enrollee and/or his/her family/representative about their ability to change from receiving care management services Remotely to In-Person at any time and how to make that change.
4. The Care Manager ensures that the enrollee’s needs are met through Remote contacts and that the care management service delivery is effective and meets quality requirements. If engaging remotely becomes unsafe, ineffective, or does not meet the enrollee’s needs, it must be discontinued.
5. The Care Manager ensures that the continued use of Remote contacts is reviewed and reaffirmed by the planning team semi-annually to coincide with the Life Plan Reviews.
6. The Care Manager will take immediate action to amend the Life Plan if the enrollee and/or the family/representative chooses to withdraw consent for the Remote care management contacts.
7. The Care Manager initiates the process to return to In-Person care management contacts if the enrollee/enrollee’s representative requests it or it is determined that Remote contacts are unsafe, ineffective, or do not meet the enrollee’s needs. This includes engaging in the person-centered planning process to discuss with the enrollee and/or the family/representative the need to move to In-Person care management contacts, making the necessary arrangements to transition to In-Person care management contacts, and updating the Life Plan.