What is Team Care?
The Team Care Program is, at the minimum, designed to fulfill requirements under Federal and Vermont rules and regulations governing Medicaid services. It is a federally mandated prescription lock-in program to prevent misuse, abuse and diversion of medications on the FDA Controlled Substance Schedule, such as opioid pain medications or sedatives.
The Team Care program is a service of the Department of Vermont Health Access (DVHA) for members who may need support getting the best healthcare available to meet their needs. Members are referred to this program through providers, claims history or other sources. Members are enrolled for a minimum of two years. Members have a right to appeal their enrollment in Team Care.
What Else is Team Care: The Team Care Mission
Team Care aims to do more than just impose federally mandated restrictions as described above. Vermont’s Team Care is a care-management initiative for members who may need additional support to focus their healthcare services in a way that could be most beneficial to them. The intent of the program is to identify and help to address un-met healthcare needs, addictions treatment needs, support access to well-coordinated primary and specialty care, and prevent misuse and abuse of regulated medications. Additionally, for members in recovery from addictions, the Team Care Program may be a valuable tool in supporting those members’ recovery efforts.
Team Care is designed to:
- Support members in accessing the best healthcare and pharmacy services available while avoiding inefficient utilization, mis-use or abuse.
- Monitor use of regulated medication for members who have utilized these medications in a manner that may indicate inadequate pain management or the need for addiction services.
- Improve coordination and quality of care for members who have been referred to Team Care.
- Identify unmet healthcare needs and/or barriers to accessing coordinated quality healthcare for potential referral to additional supports.
- Establish a method of monitoring non-emergent health care claims for members who have utilized health care services or benefits at a frequency or in an amount that is not medically necessary, as determined by current medical practice and/or the utilization guidelines.
- Identify excessive prescribing patterns by providers.