Care Management Level of Service. The care management level of service is intended for members who need assistance with care coordination, making preventive care appointments or accessing care to address the members’ chronic health condition(s). Care management is provided to help guide the member with access to care for needed health or social services to address the member’s chronic health condition(s). Care management is a purposeful plan to reach members and impact their health and health care utilization, and to coordinate all services provided to members. Through care management, the Contractor assists members in improving their health outcomes. Members who are at risk for an acute or catastrophic episode in the future may be prioritized for complex case management services. In the interim care management services will be provided as a preventive measure. The Contractor will provide comprehensive coordination services that are tailored to the individual, rely on sound medical practices, and include Medicaid-covered services. All members identified for care management services will receive all of the benefits of disease management services in addition to the additional care management supports. Newly referred members and persons with newly diagnosed conditions, increasing health services or emergency services utilization, emergency room utilization at least three (3) standard deviations outside of the mean for the population group, evidence of pharmacy non-compliance for chronic conditions and identification of special health care needs shall be considered for care management. Care management services include direct consumer contacts to assist members with scheduling, location of specialists and specialty services, transportation needs, twenty-four (24)-hour nurse call line use, general preventive (e.g. mammography) and disease specific reminders, pharmacy refill reminders, tobacco cessation and education regarding use of primary care and emergency services. The Contractor must make every effort to contact members in care management by telephone. Materials should be delivered to the member in a manner in accordance with the member’s selection as outlined in Section 4.6.2, either through postal or electronic mail direct to the consumer. Educational materials and telephonic contacts may utilize web-based education materials inclusive of clinical practice guidelines. Materials shall be developed at the fifth grade reading level and in accordance with all member communication requirements...
Care Management Level of Service. The care management level of service is intended for members who need assistance with care coordination, making preventive care appointments or EXHIBIT 1 SCOPE OF WORK – HEALTHY INDIANA PLAN accessing care to address the members’ chronic health condition(s). Care management is provided to help guide the member with access to care for needed health or social services to address the member’s chronic health condition(s). Care management is a purposeful plan to reach members and impact their health and health care utilization, and to coordinate all services provided to members. Through care management, the Contractor assists members in improving their health outcomes. Members who are at risk for an acute or catastrophic episode in the future may be prioritized for complex case management services. In the interim care management services will be provided as a preventive measure. The Contractor will provide comprehensive coordination services that are tailored to the individual, rely on sound medical practices, and include Medicaid-covered services. All members identified for care management services will receive all of the benefits of disease management services in addition to the additional care management supports. Newly referred members and persons with newly diagnosed conditions, increasing health services or Emergency services utilization, Emergency room utilization at least three (3) standard deviations outside of the mean for the population group, evidence of pharmacy non-compliance for chronic conditions, members with special health care needs, members designated as medically frail, individuals recently discharged from an Institution for Mental Disease (IMD), individuals with conditions of interest that FSSA has identified to the Contractor and/or members with member request that indicate the need for real-time, proactive intervention shall be referred and contacted telephonically or in person by a care manager or community health worker for enrollment in care management services including direct consumer contacts to assist members with scheduling, location of specialists and specialty services, transportation needs, twenty-four (24)-hour nurse call line use, general preventive (e.g. mammography) and disease specific reminders, pharmacy refill reminders, tobacco cessation and education regarding use of primary care and Emergency services. The Contractor must make every effort to contact members in care management by telephone. The Contractor shall use c...
Care Management Level of Service. The care management level of service is intended for members who need assistance with care coordination, making preventive care appointments or accessing care to address the members’ chronic health condition(s). Care management is provided to help guide the member with access to care for needed health or social services to address the member’s chronic health condition(s). Care management is a purposeful plan to reach members and impact their health and health care utilization, and to coordinate all services provided to members. Through care management, the Contractor assists members in improving their health outcomes. Members who are at risk for an acute or catastrophic episode in the future may be prioritized for complex case management services. In the interim care management services will be provided as a preventive measure. The Contractor will provide comprehensive coordination services that are tailored to the individual, rely on sound medical practices, and include Medicaid-covered services. All members identified for care management services will receive all of the benefits of disease management services in addition to the additional care management supports. Newly referred members and persons with newly diagnosed conditions, increasing health services or Emergency services utilization, Emergency room utilization at least three (3) standard deviations outside of the mean for the population group, evidence of pharmacy non-compliance for chronic conditions, members with special health care needs, individuals recently discharged from an Institution for Mental Disease (IMD), and individuals with conditions of interest that FSSA has identified to the Contractor shall be referred and contacted telephonically or in person by a care manager or community health worker for enrollment in care management services including direct consumer contacts to assist members with scheduling, location of specialists and specialty services,
Care Management Level of Service. The care management level of service is intended for members who need assistance with care coordination, making preventive care appointments or accessing care to address the members’ chronic health condition(s). Care management is provided to help guide the member with access to care for needed health or social services to address the member’s chronic health condition(s).
Care Management Level of Service. The care management level of service is intended for members who need assistance with care coordination, making preventive care appointments or accessing care to address the members’ chronic health condition(s). Care management is provided to help guide the member with access to care for needed health or social services to address the member’s chronic health condition(s). Care management is a purposeful plan to reach members and impact their health and health care utilization, and to coordinate all services provided to members. Through care management, the Contractor assists members in improving their health outcomes. Members who are at risk for an acute or catastrophic episode in the future may be prioritized for complex case management services. In the interim care management services will be provided as a preventive measure. The Contractor will provide comprehensive coordination services that are tailored to the individual, rely on sound medical practices, and include Medicaid-covered services. All members identified for care management services will receive all of the benefits of disease management services in addition to the additional care management supports. EXHIBIT 1
