Member Assessment. 5.1.1 Initial Screening In accordance with 42 CFR 438.208(b)(3), the Contractor shall conduct an initial screening of each member within ninety (90) calendar days of the effective date of enrollment to identify the member's immediate physical and/or behavioral health care needs. The Contractor must make subsequent attempts to conduct an initial screening of each member’s needs if the initial attempt to contact the member is unsuccessful. The Contractor shall make attempts to find a member’s current contact information if it is not included in the enrollment file. The initial screening will also determine the need for disease management, care management, complex case management, or RCP services as detailed in Section 5.2. The Contractor shall utilize the FSSA Health Needs Screening tool. During the initial screening, and periodically thereafter, the Contractor will review the member’s claims history, identify access or accommodation needs, language barriers, or other factors that might indicate that the member requires additional assistance. The initial screening shall also identify members who have complex or serious medical conditions that require an expedited appointment with an appropriate provider. The initial screening will ensure that members who are in ongoing treatment receive assistance in accessing appropriate care in order to avoid disruptions in services. The initial screening must include a full review of important relevant clinical information such as the provider’s assessment of conditions and the severity of illness, treatment history and outcomes, other diseases, illnesses, and health conditions as well as the member’s psychosocial, support, behavioral health and treatment needs. At minimum, the initial screening shall: • Utilize claims data, health information exchange data, information gathered in the screening, medical records and other sources to ensure care coordination and management; • Identify gaps in member’s care and facilitate communication to relevant providers, including the member’s PMP, if applicable; • Identify immediate physical and/or behavioral health needs; • Determine need for care coordination and management; • Conduct comprehensive review of clinical history; • Perform stratification based on initial assessment and historical claims data;
Member Assessment. 3.8.1.1 Initial Screening In accordance with 42 CFR 438.208(b)(3), the Contractor shall conduct an initial screening of each member within ninety (90) calendar days of the effective date of enrollment to identify the member's immediate physical and/or behavioral health care needs. Notwithstanding the foregoing, the Contractor shall use best efforts to conduct the initial screening of individuals identified as potentially medically frail as soon as practicable prior to the expiration of the member’s Verification Period. The Contractor must make subsequent attempts to conduc t an initial screening of each member’s needs if the initial attempt to contact the member is unsuccessful. The Contractor shall make attempts to find a member’s current contact information if it is not included in the enrollment file. The initial screening will also determine the need for disease management, care management, complex case management, or RCP services as detailed in Section 3.8.2. The Contractor shall utilize the FSSA Health Needs Screening tool. During the initial screening, and periodically thereafter, the Contractor will review the member’s claims history, identify access or accommodation needs, language barriers, or other factors that might indicate that the member requires additional assistance. The initial screening shall also identify members who have complex or serious medical conditions that require an expedited appointment with an appropriate provider. The initial screening will ensure that members who are in ongoing treatment receive assistance in accessing appropriate care in order to avoid disruptions in services. The initial screening must include a full review of important relevant clinical information such as the provider’s assessment of conditions and the severity of illness, treatment history and outcomes, other EXHIBIT 1 SCOPE OF WORK – HEALTHY INDIANA PLAN diseases, illnesses, and health conditions as well as the member’s psychosocial, support, behavioral health and treatment needs. At minimum, the initial screening shall: ▪ Utilize claims data, health information exchange data, information gathered in the screening, medical records and other sources to ensure care coordination and management; ▪ Identify gaps in member’s care and facilitate communication to relevant providers, including the member’s PMP, if applicable; ▪ Identify immediate physical and/or behavioral health needs; ▪ Determine need for care coordination and management; ▪ Conduct comprehen...
Member Assessment. “Member Assessment” means the amount determined annually by the Board to pay the costs of the Fencing Consortium and which is invoiced to each Member.
Member Assessment. 5.1.1 Initial Screening The Contractor shall conduct an initial screening of each member within ninety (90) calendar days of the effective date of enrollment to identify the member's immediate physical and/or behavioral health care needs. The Contractor must make subsequent attempts to conduct an initial screening of each member’s needs if the initial attempt to
Member Assessment. Group shall complete, or cause to be completed, within thirty (30) days of enrollment, a PCP Assessment Form for each new Member that selects a Group PCP as his or her PCP. Group shall update or cause to be updated, the PCP Assessment at such intervals as may be necessary based on the Member’s health care status. SWH shall notify Group PCP of the need to conduct any Initial Assessment or Ongoing Assessment.
Member Assessment. 1. Financial assessments must be completed by staff trained in Coordination of Benefits and Coordination of Care according to the CPSA Financial Screening Manual. Final Jun 6-01 Effective 7-01-01 Page 105 -------------------------------------------------------------------------------- [LOGO] Community Partnership FEE FOR SERVICE and RISK-BASED of Southern Arizona SUBCONTRACT AGREEMENT Regional Behavioral CHILDREN SERVICES Health Authority The Providence Service Corporation ------------------------------------------------- CONTRACT NUMBER: A0108 FY 01/02 --------------------------------------------------------------------------------
Member Assessment. 1. Financial assessments must be completed by staff trained in Coordination of Benefits and Coordination of Care according to the CPSA Financial Screening Manual.
Member Assessment. 1. The Contractor shall conduct an interagency intake and comprehensive, strength-based assessment at a location and time coordinated with the child and family. The intake/assessment will be completed by a Master's level clinician and include participation of the child, family, ADES, AOC, ADJC, the Contractor and anyone else appropriate.
Member Assessment. The Network conducts a comprehensive, strength-based assessment at a location and time coordinated with the child and family. The intake/assessment is completed by a Master's level clinician and includes participation of the child, family, and all appropriate state agency partner(s).
Member Assessment
