Care Management Program. The Contractor is responsible for ensuring by the contract start date that an EOHHS approved care management strategy and plan is in place, which addresses the preventive and chronic healthcare needs of its members, inclusive of behavioral health social services and supports and other social determinants that impact member health outcomes. The care management strategy and plan for members with significant health and social needs that are at high risk of poor health outcomes, including, but not limited to, adults with complex health needs, Children with Special Health Care Needs, other children with potentially care management service’s needs, individuals receiving home and community-based services or children with high need, HIV/AIDS, mental illness, addiction issues or those recently discharged from correctional facilities. The care management plan will describe the care management program including but not limited to the policies, procedures, practices and criteria for conducting the Health Risk Assessment and conducting providing care coordination and Intensive Care Management Services that comply with the requirements contained in ATTACHMENT G. The Care Management strategy and plan is subject to the approval of EOHHS. The Contractor will submit the Care Management strategy and plan to EOHHS thirty (30) days prior to the contract commencement date. The Contractor will implement processes to assess, monitor and evaluate the services to all care management subpopulations described in the care management strategy and plan, including but not limited to, defining any of the ongoing special conditions for focus of the care management program that requires a course of treatment, the frequency of ongoing care monitoring, and the number of members and their projected Medicaid eligibility category, type of disability, chronic condition, race, ethnicity, gender and age. In reference to HIV case management, for all Medicaid members, HIV positive; HIV negative; HIV medical; and HIV non-medical case management services will be considered an in-plan benefit. The Contractor will ensure that it has a robust provider network to meet the needs of the community. The Contractor will provide reporting on these services to EOHHS, at a frequency determined by EOHHS. The Contractor will ensure that all of its contracted providers for this service as in compliance with EOHHS’s HIV Targeted Care/Case Management (TCM) Provider Manual and accompanying HIV TCM Toolbox. The Contracto...
Care Management Program. The Contractor shall calculate and report on the number of engaged enrollees in the Practice Based Care Management program (PBCM) on a monthly basis and shall be paid an Engagement PPPM, upon EOHHS review and approval, on a quarterly basis. Base Per-Participant Per-Month (PPPM) Rate for Practice Based Care Management Contract. Engagement: Per Participant Per Month $175.00
Care Management Program. Contractor shall have a State approved Care Management Plan for Rhody Health Options programs. The Care Management Plan shall be submitted to the State thirty (30) days prior to the contract commencement date. The Care Management Plan shall describe the policies, procedures and practices for the areas noted below. Contractor shall comply with the required Components of Contractor’s care management program are described in Attachment M of this Contract. The Contractor shall have policies, procedures and practices that shall cover the following components of care management: (1) a Person-Centered System of Care, (2) Risk Profiling to identify members at risk (3) Principles of Care Management (4) Telephonic Initial Health Screen, (5) a Comprehensive Functional Needs Assessment, Designated Lead Care Manager, (6) a Plan of Care, (7) A Multi-Disciplinary Care Management Team (8) Conflict Free Case Management, (9) Implementation, Coordination and Monitoring of the Plan of Care, (10) Management of Care Transitions, and (11) Analysis of Care Management Effectiveness, Appropriateness, and Patient Outcomes. The Contractor shall ensure that monthly telephone contact is required for members receiving care management services. Quarterly home visits are required with one (1) home visit annually to be unannounced. Home visits for RIte @ Home members are conducted monthly. The Contractor shall establish policies and procedure to establish and use care manager to member ratios that take into consideration the member’s level of care, need for interpreters, acute and specialty care services, LTSS needs, travel time and other factors deemed appropriate by the Contractor. The care manager ratios to members shall be approved by EOHHS. Care management shall be performed by Health Plan staff or agents located in the State of Rhode Island and may be augmented by Health Plan expertise located in other areas. Rhode Island staff will be key for their ability to work closely with local resources and communities including face- to-face meetings where appropriate, to best coordinate the services and supports needed to meet the needs of members, including behavioral health needs and out-of-plan services. The Rhody Health Options Care Managers and all their needed support staff shall be located in Rhode Island. The State considers interactive communications between PCPs and specialists to be an important program objective to ensure that members receive the right care in the right setting. ...
Care Management Program. 1. The MCP must have a process to inform members and their PCPs in writing that they have been identified as meeting the criteria for care management, including their enrollment into a care management program.
Care Management Program. As part of the state’s commitment to improving services, HHSC also contracted with AxisPoint Health to develop a care management program to assess and monitor physical and behavioral healthcare outcomes. Responsible for completing an independent risk assessment on every individual residing at an SSLC, the AxisPoint Health registered nurse case managers completed nursing assessments of all residents by May 31, 2018. They continued to assess individuals who were newly admitted to an SSLC over the summer; however, the contract expires on August 31, 2018, and will not be renewed.
Care Management Program. The City of Lewiston Wellness and Health Care Management Program (the “Program”) is pleased to provide this voluntary health care management system which focuses on healthy lifestyles and healthy activities based on documented public health literature. The goal is to reduce the overall need for health care services among members and to prevent disease by rewarding employees and spouses for healthy behaviors that will contribute to healthier outcomes. The program can be broken down as follows:
