2024 Care Coordination Family Based Services Question Title * 1. In which county is your agency located? Although all responses are kept confidential, you may decline to respond to this question. OK Question Title * 2. When a PerformCare Member is first referred to treatment, the agency receives sufficient clinical information about the Member from the referral source: Majority of the time (80% of the time or more) Most of the time (50-79% of the time) Less than half of the time (49% of the time or less) Comment OK Question Title * 3. When a PerformCare Member is first referred to treatment, the agency receives accurate clinical information about the Member from the referral source: Majority of the time (80% of the time or more) Most of the time (50-79% of the time) Less than half of the time (49% of the time or less) Comment: OK Question Title * 4. When a PerformCare Member is first referred to treatment, the agency receives timely (within 10 calendar days) clinical information about the Member from the referral source: Majority of the time (80% of the time or more) Most of the time (50-79% of the time) Less than half of the time (49% of the time or less) Comment: OK Question Title * 5. How often do you invite other providers (e.g., outpatient, Targeted Case Managers, and in-home services) to treatment team meetings to obtain additional information or provide updates on treatment progress? (Telephonically or in-person) Majority of the time (80% of the time or more) Most of the time (50-79% of the time) Less than half of the time (49% of the time or less) Comment: OK Question Title * 6. How often do you contact other providers (e.g., outpatient, Targeted Case Managers, in-home services) involved in the Member’s care to coordinate after care or share discharge information? Majority of the time (80% of the time or more) Most of the time (50-79% of the time) Less than half of the time (49% of the time or less) Comment: OK Question Title * 7. When barriers are identified or pertinent clinical information arises, how often do you contact PerformCare Clinical Care Managers? Majority of the time (80% of the time or more) Most of the time (50-79% of the time) Less than half of the time (49% of the time or less) Comment: OK Question Title * 8. Is this a true statement? Ninety-five percent of the time when discharge planning is set up for the next level of care, the Member has a specific date and time of the first appointment. This excludes Members/parents/guardians who declines aftercare or left treatment against medical advice. Yes No. If no, please provide an explanation. Comment: OK Question Title * 9. Is this a true statement? Ninety-five percent of the time when discharge planning is being set up, the discharge planner includes the natural supports (e.g., parent/guardian/friend), and they are agreeable with the date and time of the first appointment? This excludes Members/parents/guardians who decline natural support involvement. Yes No. If no, please provide an explanation. Comment: OK Question Title * 10. Do the majority of other providers, such as outpatient providers, Targeted Case Managers, in-home service, respond to your outreaches within two business days? Yes No. If no, please provide the average length of time it takes another Provider to return the call with options provided: 3-7 days 8-14 days 15 days or greater Not at all Comment: OK Question Title * 11. When a PerformCare Member reports they smoke cigarettes or use vaping products, do you offer to discuss tobacco recovery, offer educational materials, or provide nicotine replacement treatment? Yes No. If no, please provide an explanation. Comment: OK Question Title * 12. When a PerformCare Member is interested in tobacco cessation treatment, do you assist the Member in finding providers for follow up or outreach to PerformCare for assistance? Yes No. If no, please provide an explanation. Comment: OK DONE