Additional Requirements for Targeted Case Management Sample Clauses

Additional Requirements for Targeted Case Management. The Health Plan shall have a case management program, including guidelines and protocols that address: (1) Caseloads set to achieve the desired results. Size limitations must clearly state the ratio of enrollees to each individual case manager. The limits shall be specified for children/adolescents and adults, with a description of the clinical rationale for determining each limitation. If the Health Plan permits “mixed” caseloads, i.e., children/adolescents and adults, a separate limitation is expected along with the rationale for the determination. Ratios must be no greater than the requirements set forth in the Medicaid Mental Health Targeted Case Management Coverage and Limitations Handbook; (2) A system to manage caseloads when positions become vacant; (3) A description of the modality of service provision and the location that services will be provided; (4) The expected frequency, duration and intensity of the service with service limits and criteria no more restrictive than those in Medicaid policy; (5) Issues related to recovery and self-care, including services to help enrollees gain independence from the behavioral health and case management system; (6) Services based on individual needs of the enrollees receiving the service. The service system shall also address the changing needs and abilities of enrollees; and (7) Case management staff with expertise and training necessary to competently and promptly assist enrollees in working with Social Security Administration or Disability Determination in maintaining benefits from SSI and SSDI. For enrollees who wish to work, case management staff must have the expertise and training necessary to help enrollees access Social Security Work Incentives. WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract
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Additional Requirements for Targeted Case Management. The Health Plan shall have a Case Management program, including clinical guidelines and protocol that addresses the issues below:
Additional Requirements for Targeted Case Management. (1) The PSN shall have a Case Management program, including clinical guidelines and protocol that addresses the issues below: (a) Caseloads must be set to achieve the desired results. Size limitations must clearly state the ratio of enrollees to each individual case manager. The limits shall be specified for children and adults, with a description of the clinical rationale for determining each limitation. If the PSN permits “mixed” caseloads, i.e., children and adults, a separate limitation is expected along with the rationale for the determination. Ratios must be no greater than the requirements set forth in the Medicaid Mental Health Targeted Case Management Coverage and Limitations Handbook. (b) A system shall be in place to manage caseloads when positions become vacant. (c) The modality of service provision, and the location that services will be provided, shall be described. (d) Case Management protocol and clinical practice guidelines, which outline the expected frequency, duration and intensity of the service, shall be available. (e) Clinical guidelines shall address issues related to recovery and self-care, including services that will assist Enrollees in gaining independence from the mental health and Case Management system. (2) The Case Management program shall have services available based on the individual needs of the Enrollees receiving the service. The service should reflect a flexible system that allows movement within a continuum of care that addresses the changing needs and abilities of Enrollees. (a) Case management staff must have expertise and training necessary to competently and promptly assist enrollees in working with Social Security Administration or Disability Determination in maintaining benefits from SSI and SSDI. For clients who wish to work, case management staff must have the expertise and training necessary to assist enrollees to access Social Security Work Incentives including development of Plans for Achieving Self-Support (PASS). (b) At a minimum, case management services are to incorporate the principles of a strengths-based approach. Strengths-based case management services are a preferred service modality for work with individuals and families. This method stresses building on the strengths of individuals and families that can be used to resolve current problems and issues. This approach counters more traditional approaches that focus almost exclusively on individuals’ deficits or needs. Service limits and criteria de...
Additional Requirements for Targeted Case Management. The Health Plan shall have a case management program, including guidelines and protocols that address: (1) Caseloads set to achieve the desired results. Size limitations must clearly state the ratio of enrollees to each individual case manager. The limits shall be specified for children/adolescents and adults, with a description of the clinical rationale for determining each limitation. If the Health Plan permits “mixed” caseloads, i.e., HealthEase of Florida, Inc. Medicaid HMO Non-Reform Contract children/adolescents and adults, a separate limitation is expected along with the rationale for the determination. Ratios must be no greater than the requirements set forth in the Medicaid Mental Health Targeted Case Management Coverage and Limitations Handbook; (2) A system to manage caseloads when positions become vacant;
Additional Requirements for Targeted Case Management. The Health Plan shall have a case management program, including guidelines and protocols that address: (1) Caseloads set to achieve the desired results. Size limitations must clearly state the ratio of enrollees to each individual case manager. The limits shall be specified for children/adolescents and adults, with a description of the clinical rationale for determining each limitation. If the Health Plan permits “mixed” caseloads, i.e., WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform Contract children/adolescents and adults, a separate limitation is expected along with the rationale for the determination. Ratios must be no greater than the requirements set forth in the Medicaid Mental Health Targeted Case Management Coverage and Limitations Handbook; (2) A system to manage caseloads when positions become vacant;

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