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2025 Care Coordination Family Based Services
1.
In which county is your agency located? Although all responses are kept confidential, you may decline to respond to this question.
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
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:
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:
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:
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:
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:
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:
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:
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:
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:
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: