Common use of Care Coordinator Caseloads Clause in Contracts

Care Coordinator Caseloads. The Contractor must include a sufficient number of Care Coordinators with the background and training to serve low, moderate, and high-risk Enrollees, based on an analysis of the population to be served in accordance with Section 2.6.2. Care Coordinators responsible for Enrollees with varying risk levels shall have their overall caseload weighted and a blended overall caseload limit set, taking into account the location of the Enrollee. The maximum weighted caseload for a Care Coordinator is 600 with low risk weighted as one (1), moderate risk weighted as four (4), and high risk weighted as eight (8). CMS and the Department may review existing caseloads at any time and require a change in methodology or an Enrollee’s assignment to a caseload.