Common use of Case Management and Coordination of Care Program Clause in Contracts

Case Management and Coordination of Care Program. (A) The Contractor shall have policies and procedures in place to assure continuity and coordination of overall oral health care for all Enrollees including a mechanism to ensure that each Enrollee has an ongoing source of Primary Care. (B) The Contractor’s case management program shall be designed around a collaborative process of assessment, planning, facilitation, and advocacy using available resources to promote quality, timely, safe and cost-effective outcomes. The Contractor shall use the information the Department provides on Enrollees with Special Health Care Needs to coordinate care and determine case management needs. (C) A case management program can include, but is not limited to: (1) Methodologies to determine the frequency and duration of case management services through application of the Dental Plan’s criteria; (2) Mechanisms to refer to and coordinate with other state agencies and community resources as necessary; (3) Assisting with and the monitoring of Enrollees’ follow-up and specialty care to ensure compliance with treatment plans and ensure that Enrollees receive recommended follow up and specialty care; (4) Coordination with the Contractor’s disease management program; (5) Referral of enrollees to Medical Homes, where appropriate; and (6) Protocols to address Enrollees who are non-compliant.

Case Management and Coordination of Care Program. (A) The Contractor shall have policies and procedures in place to assure continuity and coordination of overall oral health care for all Enrollees including a mechanism to ensure that each Enrollee has an ongoing source of Primary Care. (B) The Contractor’s case management program shall be designed around a collaborative process of assessment, planning, facilitation, and advocacy using available resources to promote quality, timely, safe and cost-effective outcomes. The Contractor shall use the information the Department provides on Enrollees with Special Health Care Needs to coordinate care and determine case management needs. (C) A case management program can include, but is not limited to: (1) Methodologies to determine the frequency and duration of case management services through application of the Dental Health Plan’s criteria; (2) Mechanisms to refer to and coordinate with other state agencies and community resources as necessary; (3) Assisting with and the monitoring of Enrollees’ follow-up and specialty care to ensure compliance with optional treatment plans and ensure that Enrollees receive recommended follow up and specialty care; (4) Coordination with the Contractor’s disease management program; (5) Referral of enrollees to Medical Homes, where appropriate; and (6) Protocols to address Enrollees who are non-compliant.