Care Management Plan Sample Clauses

Care Management Plan. A Care Management Plan to identify and address how the Participant’s physical, cognitive, and behavioral healthcare needs will be care managed, including: • Active chronic problems, current non-chronic problems, cognitive needs, and problems that were previously controlled or classified as maintenance care but have been exacerbated by disease progression or other intervening conditions. • Current medications. • All services authorized and the scope, amount, duration and frequency of the services authorized, including any services that were authorized by the CHC- MCO since the last PCSP was finalized that need to be authorized moving forward. • A schedule of preventive service needs or requirements. • Disease Management action steps. • Known needed physical and behavioral healthcare and services. • All designated points of contact and the Participant’s authorizations of who may request and receive information about the Participant’s services. • How the Service Coordinator will assist the Participant in accessing Services identified in the PCSP. • How the CHC-MCO will coordinate with the Participant’s Medicare, Veterans, BH-MCO, and other health insurers and other supports.
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Care Management Plan. A Care Management Plan to identify and address how LTSS Participants’ physical, cognitive, and behavioral healthcare needs will be care managed, including:
Sample 1Sample 2
Care Management Plan. ‌ A Care Management Plan to identify and address how the Participant’s physical, cognitive, and behavioral healthcare needs will be care managed, including: • Active chronic problems, current non-chronic problems, cognitive needs, and problems that were previously controlled or classified as maintenance care but have been exacerbated by disease progression or other intervening conditions. • Current medications. • All services authorized and the scope and duration of the services authorized, including any services that were authorized by the CHC- MCO since the last PCSP was finalized that need to be authorized moving forward. • A schedule of preventive service needs or requirements. • Disease Management action steps. • Known needed physical and behavioral healthcare and services. • All designated points of contact and the Participant’s authorizations of who may request and receive information about the Participant’s services. • How the Service Coordinator will assist the Participant in accessing Services identified in the PCSP. • How the CHC-MCO will coordinate with the Participant’s Medicare, Veterans, BH-MCO, and other health insurers and other supports.
Sample 1
Care Management Plan. A written plan that is developed with input from the Member and/or their family member(s), parent, legal guardian, authorized representative, caregiver, and/or other authorized support person(s) as appropriate to assess strengths, risks, needs, goals, and preferences, and make recommendations for clinical and non-clinical service needs.
Sample 1
Care Management Plan i. Within thirty (30) Business Days of execution of this Amendment, the PHP shall develop and submit to the Department a COVID-19 Care Management Plan. a. The COVID-19 Care Management Plan shall address how the PHP intends to use its care management processes and staff, either internal or contracted, to support COVID-19 response activities during the term of this Amendment. b. The Care Management Plan shall describe: a. How care management activities will be performed (e.g., virtual vs. in person) and how care management processes will be changed (e.g., changes to identification/outreach, new triggers for engagement, changes to Care Needs Screenings/Comprehensive Assessments/Care Plans, etc.); b. How the PHP will conduct outreach to and alter care management processes for select populations that are at high-risk of contracting or high-risk of complications associated with COVID-19; c. How the PHP will educate and train care managers in a manner that is aligned with Federal and/or State guidance, and collaborate with contracted delegated care management entities, including Tier 3 Advanced Medical Homes (Tier 3 AMHs) and Local Health Departments (LHDs) on the COVID-19 response; d. How the PHP will provide care managers with information on Members impacted by COVID-19; and e. How PHPs will connect care managers with information on testing, contact tracing, support services, vaccine administration and other aspects of the public health response to COVID-19 that aligns with Federal and/or State guidance to share with Members. ii. The Care Management Plan shall describe Long-Term Services and Supports-specific (LTSS) care management provisions, including: a. How the PHP will ensure that Members using LTSS who are engaged in care management are receiving no less than the number of care management contacts typically provided outside of the COVID-19 response; b. Innovative approaches to communicate with Members using LTSS and their families or authorized representatives; c. Strategies to address barriers to community transitions related to transportation and housing; and d. Approach for addressing the unique needs of different populations (e.g., Members in nursing homes, Members using home health or personal care services). iii. The PHP shall include within its COVID-19 Care Management Plan a timeline for implementation of efforts.
Sample 1

Related to Care Management Plan

  • Care Management The Contractor’s protocol for referring members to care management shall be reviewed by OMPP and shall be based on identification through the health needs screening or when the claims history suggests need for intervention. In addition to population-based disease management educational materials and reminders, these members should receive more intensive services. Members with newly diagnosed conditions, increasing health services or emergency services utilization, evidence of pharmacy non-compliance for chronic conditions and identification of special health care needs should be strongly considered for case management. Care management services include direct consumer contacts in order to assist members with scheduling, location of specialists and specialty services, transportation needs, 24-Hour Nurse Line, general preventive (e.g. mammography) and disease specific reminders (e.g. Xxx X0X), pharmacy refill reminders, tobacco cessation and education regarding use of primary care and emergency services. The Contractor shall make every effort to contact members in care management telephonically. Materials should also be delivered through postal and electronic direct-to-consumer contacts, as well as web-based education materials inclusive of clinical practice guidelines. Materials shall be developed at the fifth grade reading level. All members with the conditions of interest shall receive materials no less than quarterly. The Contractor shall document the number of persons with conditions of interest, outbound telephone calls, telephone contacts, category of intervention, intervention delivered, mailings and website hits. Care management shall be coordinated with the Right Choices Program for members qualifying for the Right Choices Program. However, the Right Choices Program is not a replacement for care management.

  • Management Plan The Management Plan is the description and definition of the phasing, sequencing and timing of the major Individual Project activities for design, construction procurement, construction and occupancy as described in the IPPA.

  • Project Management Plan 3.2.1 Developer is responsible for all quality assurance and quality control activities necessary to manage the Work, including the Utility Adjustment Work. Developer shall undertake all aspects of quality assurance and quality control for the Project and Work in accordance with the approved Project Management Plan, Good Industry Practice and applicable Law. 3.2.2 Developer shall develop the Project Management Plan and its component parts, plans and other documentation in accordance with the requirements set forth in Section 1.5.2.5

  • Construction Management Plan Contractor shall prepare and furnish to the Owner a thorough and complete plan for the management of the Project from issuance of the Proceed Order through the issuance of the Design Professional's Certificate of Material Completion. Such plan shall include, without limitation, an estimate of the manpower requirements for each trade and the anticipated availability of such manpower, a schedule prepared using the critical path method that will amplify and support the schedule required in Article 2.1.5 below, and the Submittal Schedule as required in Article 2.2.3. The Contractor shall include in his plan the names and resumés of the Project Superintendent, Project Manager and the person in charge of Safety.

  • Health Plan An appropriately licensed entity that has entered into a contract with Subcontractor, either directly or indirectly, under which Subcontractor provides certain administrative services for Health Plan pursuant to the State Contract. For purposes of this Appendix, Health Plan refers to UnitedHealthcare Insurance Company.

  • Dental Care Plan The Welfare Plan will include a Dental Care Plan which will reimburse members for expenses incurred in respect of the coverages summarized in Appendix "1". The Plan will not duplicate benefits provided now or which may be provided in the future by any government program.

  • Executive Management The PH-MCO must include in its Executive Management structure: • A full-time Administrator with authority over the entire operation of the PH-MCO. • A full-time HealthChoices Program Manager to oversee the operation of the Agreement, if different than the Administrator. • A full-time Medical Director who is a current Pennsylvania-licensed physician. The Medical Director must be actively involved in all major clinical program components of the PH-MCO and directly participates in the oversight of the SNU, QM Department and UM Department. The Medical Director and his/her staff/consultant physicians must devote sufficient time to the PH-MCO to provide timely medical decisions, including after-hours consultation, as needed. • A full-time Pharmacy Director who is a current Pennsylvania-licensed pharmacist. The Pharmacy Director oversees the outpatient drug management and serves on the PH-MCO P&T Committee. • A Dental Director who is a current Pennsylvania-licensed Doctor of Dental Medicine or Doctor of Dental Surgery. The Dental Director may be a consultant or employee but must be available at a minimum of 30 hours per week. The Dental Director must be actively involved in all program components related to dental services including, but not limited to, dental provider recruitment strategy, assessment of dental network adequacy, providing oversight and strategic direction in the quality of dental services provided, actively engaged in the development and implementation of quality initiatives, and monitor the performance of the dental benefit manger if dental benefits are subcontracted. A full-time Director of Quality Management who is a Pennsylvania- licensed RN, physician or physician's assistant or is a Certified Professional in Healthcare Quality by the National Association for Healthcare Quality Certified in Healthcare Quality and Management by the American Board of Quality Assurance and Utilization Review Providers. The Director of Quality Management must be located in Pennsylvania and have experience in quality management and quality improvement. Sufficient local staffing under this position must be in place to meet QM Requirements. The primary functions of the Director of Quality Management position are: • Evaluate individual and systemic quality of care • Integrate quality throughout the organization • Implement process improvement • Resolve, track, and trend quality of care complaints • Develop and maintain a credentialed Provider network • A full-time CFO to oversee the budget and accounting systems implemented by the PH-MCO. The CFO must ensure the timeliness and accuracy of all financial reports. The CFO shall devote sufficient time and resources to responsibilities under this Agreement. • A full-time Information Systems Coordinator, who is responsible for the oversight of all information systems issues with the Department. The Information Systems Coordinator must have a good working knowledge of the PH-MCO's entire program and operation, as well as the technical expertise to answer questions related to the operation of the information system. • These full time positions must be solely dedicated to the PA HealthChoices Program.

  • Disease Management If you have a chronic condition such as asthma, coronary heart disease, diabetes, congestive heart failure, and/or chronic obstructive pulmonary disease, we’re here to help. Our tools and information can help you manage your condition and improve your health. You may also be eligible to receive help through our care coordination program. This voluntary program is available at no additional cost you. To learn more about disease management, please call (000) 000-0000 or 0-000-000-0000. Our entire contract with you consists of this agreement and our contract with your employer. Your ID card will identify you as a member when you receive the healthcare services covered under this agreement. By presenting your ID card to receive covered healthcare services, you are agreeing to abide by the rules and obligations of this agreement. Your eligibility for benefits is determined under the provisions of this agreement. Your right to appeal and take action is described in Appeals in Section 5. This agreement describes the benefits, exclusions, conditions and limitations provided under your plan. It shall be construed under and shall be governed by the applicable laws and regulations of the State of Rhode Island and federal law as amended from time to time. It replaces any agreement previously issued to you. If this agreement changes, an amendment or new agreement will be provided.

  • SITE MANAGEMENT We reserve the right, but not the obligation, to: (1) monitor the Site for violations of these Terms of Use; (2) take appropriate legal action against anyone who, in our sole discretion, violates the law or these Terms of Use, including without limitation, reporting such user to law enforcement authorities; (3) in our sole discretion and without limitation, refuse, restrict access to, limit the availability of, or disable (to the extent technologically feasible) any of your Contributions or any portion thereof; (4) in our sole discretion and without limitation, notice, or liability, to remove from the Site or otherwise disable all files and content that are excessive in size or are in any way burdensome to our systems; and (5) otherwise manage the Site in a manner designed to protect our rights and property and to facilitate the proper functioning of the Site.

  • Vision Care Plan The County agrees to provide a Vision Care Plan for all employees and dependents. The Plan will be the Vision Service Plan - Plan A with benefits at 12/12/24 month intervals and with twenty dollar ($20.00) deductible for examinations and twenty dollar ($20.00) deductible for materials. The County will fully pay the monthly premium for the employee and dependents and pick up inflationary costs during the term of the Agreement.

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