Common use of Caseloads Clause in Contracts

Caseloads. HMOs must allow care management staff and the WICT adequate time to effectively coordinate the delivery of integrated care. In order to do so, HMOs must have strategies in place to monitor care management team workloads and to assure that each team member is assigned a manageable caseload based on their roles and responsibilities within the team. HMOs must develop and maintain written caseload standards in consideration of the following: a) The complexity of the cases. b) The need for licensed health care professionals and other care management staff to coordinate with other providers and community resources. c) The need for face-to-face contacts with the member, providers, and others instrumental to meeting the needs of the member. d) Management duties, including providing direction to care management team members and ensuring adequate documentation of care management activities.

Caseloads. HMOs must allow care management staff and the WICT adequate time to effectively coordinate the delivery of integrated care. In order to do so, HMOs must have strategies in place to monitor care management team workloads and to assure that each team member is assigned a manageable caseload based on their roles and responsibilities within the team. HMOs must develop and maintain written caseload standards in consideration of the following: a) i. The complexity of the cases. b) ii. The need for licensed health care professionals and other care management staff to coordinate with other providers and community resources. c) iii. The need for face-to-face contacts with the member, providers, and others instrumental to meeting the needs of the member. d) iv. Management duties, including providing direction to care management team members and ensuring adequate documentation of care management activities.