Medical Services for Special Populations. The Contractor shall implement mechanisms to assess each member identified by the State and identified to the Contractor by the State as having special health care needs in order to identify any ongoing special condition of the member that requires a course of treatment or regular care monitoring. The assessment mechanism must use appropriate health care professionals. The Contractor must have a mechanism in place to allow members to directly access a specialist as appropriate for the member’s condition and identified needs (for example, through the standard referral or an approved number of visits). The Contractor shall determine the need for any enhanced services that may be necessary for these populations to maintain their health and well being. The MHN Policy and Procedure Guide outlines the best practices and procedures that the SC State Plan for Medical Assistance uses to serve the designated special populations. Children with chronic/complex health care needs and all infants of high- risk mothers are defined as special populations in the SC State Plan for Medical Assistance. The special populations are identified as individuals that may require additional health care services that should be incorporated into a health management plan which guarantees that the most appropriate level of care is provided for these individuals
Medical Services for Special Populations. If Provider is a PCP, Provider shall assess Covered Persons for special health care needs (“SHCN”) and notify Health Plan of those Covered Persons who meet SCHN criteria as soon as possible after identification.
Medical Services for Special Populations. The Contractor shall implement mechanisms to assess each member identified as having special health care needs in order to identify any ongoing special condition of the member that requires a course of treatment or regular care monitoring. The assessment mechanism must use appropriate health care professionals. The Contractor must have a mechanism in place to allow members to directly access a specialist as appropriate for the member’s condition and identified needs (for example, through the standard referral or an approved number of visits). The Contractor shall determine the need for any enhanced services that may be necessary for these populations to maintain their health and well being. The Policy and Procedure Guide, Best Practices, outlines the best practices and procedures that the Title XXI SC State SCHIP Plan uses to serve the designated special populations. Expenditures for the health care services of the special populations as previously described have been factored into the capitated rate described in §2.1 of this Contract and the Contractor will not receive any additional payments. Children with chronic/complex health care needs are defined as a special population in the Title XXI SC State SCHIP Plan. The special population is identified as individuals that may require additional health care services that should be incorporated into a health management plan, which guarantees that the most appropriate level of care is provided for these individuals.
Medical Services for Special Populations. The Contractor shall implement mechanisms to assess each member identified by the State and identified to the Contractor by the State as having special health care needs in order to identify any ongoing special condition of the member that requires a course of treatment or regular care monitoring. The assessment mechanism must use appropriate health care professionals. The Contractor must have a mechanism in place to allow members to directly access a specialist as appropriate for the member’s condition and identified needs (for example, through the standard referral or an approved number of visits). The Contractor shall determine the need for any enhanced services that may be necessary for these populations to maintain their health and well -being. MCO Policy and Procedure Guide outlines the best practices and procedures that the Title XIX SC State Medicaid Plan uses to serve the designated special populations. Expenditures for the health care services of the special populations as previously described have been factored into the capitated rate described in § 2.1 of this Contract and the Contractor will not receive any additional payments. Children with chronic/complex health care needs and all infants of high risk mothers are defined as special populations in the Title XIX SC State Medicaid Plan. The special populations are identified as individuals that may require additional health care services that should be incorporated into a health management plan which guarantees that the most appropriate level of care is provided for these individuals.
Medical Services for Special Populations. The CCN shall identify members with special health care needs within ninety-
Medical Services for Special Populations. The Contractor shall implement mechanisms to assess each Medicaid MCO Member identified by the Department and identified to the Contractor by the Department as having special health care needs in order to identify any ongoing special condition of the Medicaid MCO Member that requires a course of treatment or regular care monitoring. The assessment mechanism must use appropriate Health Care Professionals. The Contractor must have a mechanism in place to allow Medicaid MCO Members to directly access a specialist as appropriate for the member’s condition and identified needs (for example, through the standard referral or an approved number of visits). The Contractor shall determine the need for any enhanced services that may be necessary for these populations to maintain their health and well - being. The MCO Policy and Procedure Guide outlines the best practices and procedures that the State Plan uses to serve the designated special populations. Expenditures for the health care services of the special populations as previously described in this Section 4.7 have been factored into the Capitation Payment described in § 2.1 of this Contract and the Contractor will not receive any additional payments for these services. Children with chronic/complex health care needs and all infants of high risk mothers are defined as special populations in the State Plan. The special populations are identified as individuals that may require additional health care services that should be incorporated into a health management plan which guarantees that the most appropriate level of care is provided for these individuals.
