Care Coordination/Case Management. A process that assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet an enrollee’s health needs using communication and all available resources to promote quality outcomes. Proper care coordination/case management occurs across a continuum of care, addressing the ongoing individual needs of an enrollee rather than being restricted to a single practice setting. Case Record — A record that includes information regarding the management of services for an enrollee including the plan of care and documentation of care coordination/case management activities.
Care Coordination/Case Management. A process that assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet an enrollee's health needs using communication and all available resources to promote quality cost-effective outcomes. Proper case management occurs across a continuum of care, addressing the ongoing individual needs of an enrollee rather than being restricted to a single practice setting. For purposes of this Contract, “care coordination” and “case management” are the same. Catastrophic Component – (Reform Health Plans only) - The amount of financial risk assumed by a Health Plan or the Agency to provide covered services above $50,000 per enrollee, based on Medicaid fee-for-service payment levels, and up to the overall annual benefit maximum.
Care Coordination/Case Management. A process that assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet an enrollee’s health needs using communication and all available resources to promote quality cost- effective outcomes. Proper case management occurs across a continuum of care, addressing the ongoing individual needs of an enrollee rather than being restricted to a single practice setting. For purposes of this Contract, “care coordination” and “case management” are the same. Catastrophic Component - (Reform Health Plans only) — The amount of financial risk assumed by a Health Plan or the Agency to provide covered services above $50,000 per enrollee, based on Medicaid fee-for-service payment levels, and up to the overall annual benefit maximum. Catastrophic Component Threshold - (Capitated Reform Health Plans in counties where no HMO is present and Reform FFS PSNs only) — The point at which the cost of covered services, based on Medicaid fee-for-service payment levels, reaches $50,000 for an enrollee in a Contract year. For a Health Plan that accepts the comprehensive capitation rate only, the Agency begins reimbursing the Health Plan for the cost of covered services received by the enrollee for the remainder of the Contract year. This reimbursement is based on a percentage of Medicaid fee-for-service payment levels.
