Common use of Additional Requirements for Targeted Case Management Clause in Contracts

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

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; andand AMERIGROUP Florida, Inc. d/b/a Medicaid Non-Reform and Reform AMERIGROUP Community Care HMO Contract (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.