Care Treatment Plan. The care treatment plan is defined by ODJFS as the one developed by the MCP for the member. Appendix G Aged, Blind or Disabled (ABD) population Page 12 The development of the care treatment plan must be based on the comprehensive health assessment and reflect the member’s primary medical diagnosis and health conditions, any comorbidities, and the member’s psychological, behavioral health and community support needs. The care treatment plan must also include specific provisions for periodic reviews (i.e., no less than semi-annually) of the member’s condition and appropriate updates to the plan. The member and the member’s PCP must be actively involved in the development of and revisions to the care treatment plan. The designated PCP is the provider, or specialist, who will manage and coordinate the overall care for the member. Ongoing communication regarding the status of the care treatment plan may be accomplished between the MCP and the PCP’s designee (i.e., qualified health professional). Revisions to the clinical portion of the care treatment plan should be completed in consultation with the PCP. The elements of a comprehensive care treatment plan include: Goals and actions that address medical, social, behavioral and psychological needs; Member level interventions, (i.e., referrals and making appointments) that assist members in obtaining services, providers and programs; Continuous review, revision and contact follow-up, as needed, to ensure the care treatment plan is adequately monitored including the following: • Documentation that services are provided in accordance with the care treatment plan; • Re-evaluation to determine if the care treatment plan is adequate to meet the member’s current needs; • Identification of gaps between recommended care and actual care provided; • A change in needs or status from the re-evaluation that requires revisions to the care treatment plan; • Active participation by the member or representative in the care treatment plan development; • Monitoring of specific service delivery including service utilization; and • Re-evaluation of a member’s risk stratification level with adjustment to the level of case management services provided.
Care Treatment Plan. The MCP must assure and coordinate the placement of the member into case-management – including identification of the member’s need for services, completion of the comprehensive health needs assessment, and development of a care treatment plan - within ninety (90) days of membership. The care treatment plan is defined by ODJFS as the one developed by the MCP for the member. The development of the care treatment plan must be based on the comprehensive health assessment and reflect the member’s primary medical diagnosis and health conditions, any comorbidities, and the member’s psychological, behavioral health and community support needs. The care treatment plan must also include specific provisions for periodic reviews (i.e., no less than semi-annually) of the member’s condition and appropriate updates to the plan. The member and the member’s PCP must be actively involved in the development of and revisions to the care treatment plan. The designated PCP is the physician, or specialist, who will manage and coordinate the overall care for the member. Ongoing communication regarding the status of the care treatment plan may be accomplished between the MCP and the PCP’s designee (i.e., qualified health professional). Revisions to the clinical portion of the care treatment plan should be completed in consultation with the PCP.
Care Treatment Plan. The MCP must assure and coordinate the placement of the member into case-management- including identification of the member's need for services, completion of the comprehensive health needs assessment, and development of a care treatment plan - within ninety (90) days of membership. The care treatment plan is defined by ODJFS as the one developed by the MCP for the member. The development of the care treatment plan must be based on the comprehensive health assessment and reflect the member's primary medical diagnosis and health conditions, any comorbidities. and the member's psychological, behavioral health and community support needs. The care treatment plan must also include specific provisions for periodic reviews of the member's condition and appropriate updates to the plan. The member and the member's PCP must be actively involved in the development of and revisions to the care treatment plan. The designated PCP is the physician, or specialist, who will manage and coordinate the overall care for the member. Ongoing communication regarding the status of the care treatment plan may be accomplished between the MCP and the PCP's designee (i.e., qualified health professional). Revisions to the clinical portion of the care treatment plan should be completed in consultation with the PCP. Coordination of Care and Communication The MCP must arrange or provide for professional case management services that are performed collaboratively by a team of professionals appropriate for the member's condition and health care needs. At a minimum, the MCP's case manager must attempt to coordinate with the member's case manager from other health systems, including behavioral health. The MCP must have a process to facilitate, maintain, and coordinate both care and communication with the member, PCP, and other service providers and case managers. The MCP must also have a process to coordinate care for a member that is receiving services from state sub-recipient agencies as appropriate [e.g., the Ohio Department of Mental Health (ODMH); the Ohio Department of Mental Retardation and Developmental Disabilities (ODMR/DD); and the Ohio Department of Alcohol and Drug Addiction Services (ODADAS)]. There should be an accountable point of contact at the MCP for each member in case management who can help obtain medically necessary care, assist with health-related services and coordinate care needs, including behavioral health. The MCP must have a provision to disseminate information ...
Care Treatment Plan. The care treatment plan is defined by ODJFS as the one developed by the MCP for the member. The development of the care treatment plan must be based on the health assessment, and reflect the member’s health care needs. The care treatment plan must also include specific provisions for periodic reviews of the member's health care needs. Periodic reviews may include administrative data reviews or screening questions to alert appropriately qualified MCP staff to update the health assessment and the care treatment plan. The frequency of contact with the member must correspond to the member’s risk stratification level, and must include a provision for two-way communication or feedback between the member and the MCP. Appendix G Covered Families and Children (CFC) population The member and the member's PCP must be actively involved in the development of, and revisions to, the care treatment plan. The designated PCP is the provider, or specialist, who will manage and coordinate the overall care for the member. Ongoing communication regarding the status of the care treatment plan may be accomplished between the MCP and the PCP's designee (i.e., qualified health professional). Revisions to the clinical portion of the care treatment plan should be completed in consultation with the PCP. The elements of a care treatment plan include:
(a) Goals and actions that address health care conditions identified in the health assessment;
(b) Member level interventions (i.e., referrals and making appointments) that assist members in obtaining services, providers and programs related to the health care conditions identified in the health assessment;
(c) Continuous review, revision and contact follow-up, as needed, with members to insure the care treatment plan is adequately monitored including the following: • Identification of gaps between recommended care and actual care provided; and • Re-evaluation of a member's risk level with adjustment to the level of care management services provided. The MCP must address care treatment plan components as specified in ODJFS Care Management Program Requirements.
Care Treatment Plan. The care treatment plan is defined by ODJFS as the one developed by the MCP for the member. The development of the care treatment plan must be based on the comprehensive health assessment, and reflect the member’s medical condition(s), including physical, behavioral, social, and psychological needs, as well as co-morbidities. The care treatment plan must also include specific provisions for periodic reviews of the member's health care needs. Periodic reviews may include administrative data reviews or screening questions to alert appropriately qualified MCP staff to update the comprehensive health assessment and the care treatment plan. At a minimum, there must be verbal/written contact with the member once every six (6) months. The MCP must ensure there is a provision for two-way communication or feedback with the MCP. The member and the member's PCP must be actively involved in the development of, and revisions to, the care treatment plan. The designated PCP is the provider, or specialist, who will manage and coordinate the overall care for the member. Ongoing communication regarding the status of the care treatment plan may be accomplished between the MCP and the PCP's designee (i.e., qualified health professional). Revisions to the clinical portion of the care treatment plan should be completed in consultation with the PCP. The elements of a care treatment plan include: Goals and actions that address health care conditions identified in the comprehensive health assessment; Member level interventions (i.e., referrals and making appointments) that assist members in obtaining services, providers and programs related to the health care conditions identified in the comprehensive health assessment;
