Care Management Requirements for All Members Sample Clauses

Care Management Requirements for All Members. Information Sharing for New Members HMOs must have policies and procedures to utilize member-specific information provided by DHS to prevent duplication of activities and as input into any needs stratification or care plan development activities. This may include results of any screens completed by the member, claims/encounter history, FFS prior authorization data, high-risk pregnancy indicators, and upcoming non-emergency medical transportation trips. (Pursuant to 42 CFR § 438.208(b)(4)) HMOs must also follow information sharing as written under Article VII. G.7. Screening Requirements Pursuant to 42 CFR § 438.208(b)(3), the HMO must make a best effort to conduct an initial screening of each member’s needs, within 90 days of HMO enrollment for all new BadgerCare Plus members, and within 60 days of enrollment for new Medicaid SSI members, including subsequent attempts if the initial attempt to contact the member is unsuccessful. New members include those that were previously enrolled in the HMO but re-enroll in the HMO at least six months after their last disenrollment. See Article III.B. and C for BadgerCare Plus and SSI specific screening requirements. Primary Care Provider Assignment

Care Management Requirements for All Members. 1. Information Sharing for New Members HMOs must have policies and procedures to utilize member-specific information provided by DHS to prevent duplication of activities and as input into any needs stratification or care plan development activities. This may include results of any screens completed by the member, claims/encounter history, FFS prior authorization data, high-risk pregnancy indicators, and upcoming non-emergency medical transportation trips. (Pursuant to 42 CFR § 438.208(b)(4)) HMOs must also follow information sharing as written under Art. VII, F, 7.

Care Management Requirements for All Members