Care Coordination Assignment. 4.4.5.1 The CONTRACTOR's Care Coordination program description shall specify the CONTRACTOR’s process for the assignment of a Care Coordination Level, a change in Care Coordination Level, assignment of care coordinators, and care coordinator caseload ratios. The process shall be consistent with the Care Coordination assignment requirements in this Section 4.4.5 and dependent on the outcome of the CNA.
4.4.5.2 Care Coordination Level Zero (CCL0)
4.4.5.2.1 The CONTRACTOR shall assign Members to CCL 0, as follows: 4.
4.5.2.1.1 Members the CONTRACTOR was unable to reach after making
Care Coordination Assignment i. Upon notification from ODM that a member will be enrolled with, or disenrolled from, the OhioRISE Plan for behavioral health services, the MCP must assign an MCP care coordination staff person to lead the MCP's responsibilities for the coordinating the transition of behavioral health care to and from the OhioRISE Plan.
ii. The MCP must ensure that the members disenrolling from the OhioRISE Plan have an assigned MCP care coordination staff member for at least 90 calendar days following disenrollment to assist members with accessing needed services and resources.
Care Coordination Assignment. 4.4.5.1 The CONTRACTOR's Care Coordination program description shall specify the CONTRACTOR’s process for the assignment of a Care Coordination Level, a change in Care Coordination Level, assignment of care coordinators, and care coordinator caseload ratios. The process shall be consistent with the Care Coordination assignment requirements in this Section 4.4.5 and dependent on the outcome of the CNA.
4.4.5.2 Care Coordination Level Two (CCL2)
4.4.5.2.1 The CONTRACTOR shall assign CCL2, at a minimum, to Members with one (1) or more of the following factors:
4.4.5.2.1.1 Has multi-comorbidity;
4.4.5.2.1.2 Has high emergency room use, defined as three (3) or more emergency room visits in ninety (90) days;
4.4.5.2.1.3 Has a mental health or substance abuse condition causing moderate functional impairment;
4.4.5.2.1.4 Requires assistance with two (2) or more ADLs and/or IADLs and is living in the community at low risk;
4.4.5.2.1.5 Has mild cognitive deficits requiring prompting or cues:
4.4.5.2.1.6 Has poly-pharmaceutical use, which is defined as simultaneous use of six (6) or more medications from different drug classes and/or simultaneous use of three (3) or more medications from the same drug class;
4.4.5.2.1.7 Is a Member with a high risk pregnancy (including pregnant Members who are eighteen (18) years and younger);
4.4.5.2.1.8 Is a CISC;
4.4.5.2.1.9 Is a Justice-Involved Member (refer to Section 5.12 of the Managed Care Policy Manual for details); or
4.4.5.2.1.10 Is a CARA Member.
4.4.5.3 Care Coordination Level Three (CCL3)
4.4.5.3.1 The CONTRACTOR shall assign to CCL3, at a minimum, to Members with one (1) or more of the following factors:
4.4.5.3.1.1 Is medically complex or fragile;
4.4.5.3.1.2 Has excessive emergency room use, which is defined as three (3) or more emergency room visits in sixty (60) days;
4.4.5.3.1.3 Has a mental health or substance abuse condition causing high functional impairment;
4.4.5.3.1.4 Has untreated substance dependency based on the current Diagnostic and Statistical Manual of Mental Disorders (DSM) or other functional scale determined by the State;
4.4.5.3.1.5 Requires assistance with two (2) ADLs or IADLs and is living in the community at medium to high risk;
4.4.5.3.1.6 Has significant cognitive deficits; or 4.4.5.3.1.7 Has contraindicated pharmaceutical use.
4.4.5.4 Changes in CCL
4.4.5.4.1 The CONTRACTOR shall identify Members who may need a change in CCL. The CONTRACTOR shall assess a Member’s need for a change in CCL ...
Care Coordination Assignment. 4.4.5.1 The CONTRACTOR's Care Coordination program description shall specify the CONTRACTOR’s process for the assignment of a Care Coordination Level, a change in Care Coordination Level, assignment of care coordinators, and care coordinator caseload ratios. The process shall be consistent with the Care Coordination assignment requirements in this Section 4.4.5 and dependent on the outcome of the CNA.
4.4.5.2 Care Coordination Level Zero (CCL0)
