CASE MANAGEMENT PROGRAM. The Case Management Program is a service for Members with complex medical needs or who may be at risk for future adverse health events due to an existing medical condition or who may require a wide variety of resources, information, and specialized assistance to help them manage their health and improve their quality of life. The program assigns an experienced case management nurse or coordinator to a Member or family caretaker to help make arrangements for needed care or to provide assistance in locating available community resources. Case management services provided to Members are numerous and are always tailored to the individual needs of a member. Participation in the Case Management Program is voluntary and involves no additional cost to our Members. Services often include, but are not limited to: Assistance with coordination of care; Discussion of disease processes; Facilitating arrangements for complex surgical procedures, including organ and tissue transplants; Facilitating arrangements for home services and supplies, such as durable medical equipment and home nursing care; or Identification and referral to available community resources, programs; or organizations. This program is comprised of a dedicated oncology case management team of specially trained staff experienced in cancer care and end-of-life issues who provide assessment and support to members at all stages of adjustment to a cancer diagnosis. Core goals of this program include education regarding early symptom identification and pain management, increased member understanding of and satisfaction with their treatment plan, improved overall quality of life, and improved coping surrounding end-of-life issues. Care coordination benefits of the program include: management of care and services between the members, their family, providers, vendors, and the health plan; appropriate utilization of services; and the potential for cost savings through reductions in potentially avoidable admissions and emergency department use This program is comprised of a dedicated transplant case management team specially trained and experienced in transplant care that provides assessment, education, and support during the transplant process. Core goals of this program include education and support regarding treatments, medical benefit plan, and Blue Distinction® Centers for Transplants. Care Coordination benefits of the program include: coordinating the exchange of information between the hospital, ...
CASE MANAGEMENT PROGRAM. Aging and Adult Services (AAS) will pay the contractor in consideration of Case Management Program services rendered through OAA Title IIIB funds. The reimbursement amounts are calculated based on the follow formula: Actual Expenditure minus (-) Matching and Non-Matching Contribution equals (=) Total Reimbursement amount. If the Contractor prefers to have the reimbursement amount equally spread throughout the contract year, this can be achieved by utilizing the reimbursement formula indicated above, as long as the total reimbursement amount does not exceed the total cost of the services rendered. The maximum reimbursement for the Case Management Program during the contract term July 1, 2009 through June 30, 2010 shall not exceed THIRTY-FIVE THOUSAND DOLLARS ($35,000).
CASE MANAGEMENT PROGRAM. Aging and Adult Services will pay the contractor in consideration of Case Management Program services rendered through OAA funds, the rate of one- twelfth of the total reimbursement for this program per month, as long as this amount does not exceed the total cost of case management services rendered. The maximum reimbursement for the Case Management Program during the contract term July 1, 2007 through June 30, 2008 shall not exceed THIRTY-FIVE THOUSAND DOLLARS ($35,000).
CASE MANAGEMENT PROGRAM. If you have injuries or an illness that may extend for some time, the Plan provides for services through case management. For example, if you are facing an extended period of care or treatment and these services may be accomplished in a skilled nursing facility or in your home, the case management program may be helpful in facilitating and coordinating this care. This can be beneficial to you because these settings may offer cost savings as well as other advantages to you and your family. When reviewing claims for the case management program, the case management provider always works with you, your family, and your physician so you receive close, personal attention. Through case management, the case management provider can consider recommendations involving expenses usually not covered for reimbursement. This includes suggestions to use alternative medical management techniques or procedures, or suggestions for cost-effective use of existing Plan provisions such as home health care and convalescent facilities. In order to be considered for payment under the Plan, the alternative care must result in savings without detracting from the quality of care. You, your provider, and the Plan must approve alternate care before it is provided in order to be covered by the Plan. Case management is voluntary. There is no penalty for not participating in case management or for leaving the case management program during its course. If you have questions regarding case management and its possible application to you, call the Administrative Office.
CASE MANAGEMENT PROGRAM. The INSURER must develop and effectively implement a case management system in order to monitor high risk cases and provide assistance to the covered health care needs of the beneficiaries and dependents within the said category. The Case Management System must coordinate with services available and provided in the beneficiaries’ communities and their home as needed. Not limited to the physician’s office, mental health provider professionals office, or specialty center.
CASE MANAGEMENT PROGRAM. The TPA must develop and effectively implement a case management system in order to monitor high risk cases and provide assistance to the covered health care needs of the beneficiaries and dependents within the said category. The Case Management System must coordinate with services available and provided in the beneficiaries’ communities and homes as needed. Not limited to the physician’s office, mental health provider professionals office, or specialty center.
CASE MANAGEMENT PROGRAM. A. Units of Service
CASE MANAGEMENT PROGRAM. The Case Management Program is a service for Members with complex medical needs or who may be at risk for future adverse health events due to an existing medical condition or who may require a wide variety of resources, information, and specialized assistance to help them manage their health and improve their quality of life. The program assigns an experienced case management nurse or coordinator to a Member or family caretaker to help make arrangements for needed care or to provide assistance in locating available community resources. Case management services provided to Members are numerous and are always tailored to the individual needs of a member. Participation in the Case Management Program is voluntary and involves no additional cost to our Members. Services often include, but are not limited to: Assistance with coordination of care; Discussion of disease processes; Facilitating arrangements for complex surgical procedures, including organ and tissue transplants; Facilitating arrangements for home services and supplies, such as durable medical equipment and home nursing care; or Identification and referral to available community resources, programs; or organizations. This program is comprised of a dedicated oncology case management team of specially trained staff experienced in cancer care and end-of-life issues who provide assessment and support to members at all stages of adjustment to a cancer diagnosis. Core goals of this program include education regarding early symptom identification and pain management, increased member understanding of and satisfaction with their treatment plan, improved overall quality of life, and improved coping surrounding end-of-life issues. Care coordination benefits of the program include: management of care and services between the members, their family, providers, vendors, and the health plan; appropriate utilization of services; and the potential for cost savings through reductions in potentially avoidable admissions and emergency department use.
CASE MANAGEMENT PROGRAM. The Case Management Program is a service for Members with complex medical needs or who may be at risk for future adverse health events due to an existing medical condition or who may require a wide variety of resources, information, and specialized assistance to help them manage their health and improve their quality of life. The program assigns an experienced case management nurse or coordinator to a Member or family caretaker to help make arrangements for needed care or to provide assistance in locating available community resources. Case management services provided to Members are numerous and are always tailored to the individual needs of a member. Participation in the Case Management Program is voluntary and involves no additional cost to our Members. Services often include, but are not limited to: Assistance with coordination of care; Discussion of disease processes; Facilitating arrangements for complex surgical procedures, including organ and tissue transplants; Facilitating arrangements for home services and supplies, such as durable medical equipment and home nursing care; or Identification and referral to available community resources, programs; or organizations.
