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. 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 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 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; • Determine clinical, psychosocial, functional and financial needs with appropriate referrals to community-based organizations or MCE programs; • Gather information regarding le...
Member Assessment. 3.8.1.1 Initial Screening
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.
2. The initial clinical assessment must be completed by a staff who has a master's degree in a human service or related field and who is trained, credentialed and privileged in performing assessments of behavioral health disorders, including substance use and abuse disorders. Final Jun 6-01 Effective 7-01-01 Page 119 -------------------------------------------------------------------------------- [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 --------------------------------------------------------------------------------
3. The following assessments are required to be completed at intake, every 6 months, six months prior to tuning 18, upon closure and at the time of significant change in behavior or functional level: . Arizona Level of Functioning Assessment (ALFA) . Service Level Check Guidelines . Member Assessment Form . Clinical Global Impression (CGI) for persons receiving medications at intake or when prescribing of medication begins
4. A comprehensive Psychosocial Assessment is completed on all Members upon intake and updated annually. The Psychosocial assessment included in the CPSA Clinical Documentation Manual may be used. In addition to the psychosocial assessment, the Contractor must implement a screening protocol for use with all individuals to determine if the Member has issues of substance abuse or substance dependence. Staff must be trained in the administration of standardized screening tools such as the MAST, the DAST, the CAGE or other substance abuse screening tools.
5. The following additional or more intensive assessments may need to occur based on information gathered in the initial clinical assessment: . Psychological Evaluation . Psychiatric Evaluation . Neurological Evaluation . Special assessment of Members with Mental Retardation and other Developmental Disabilities . Comprehensive substance abuse disorders evaluation . Identification of and assessment of victims of abuse and neglect
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. 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 --------------------------------------------------------------------------------
2. The initial clinical assessment must be completed by a staff who has a master's degree in a human service or related field and who is trained, credentialed and privileged in performing assessments of behavioral health disorders, including substance use and abuse disorders.
3. The following assessments are required to be completed at intake, every 6 months, six months prior to turning 18, upon closure and at the time of significant change in behavior or functional level:
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.
2. The Contractor will assess children and family members for Non-Title XIX status to ensure eligibility for services funded by HB 2003.
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.
2. The following assessments are required to be completed at intake, every 6 months, six months prior to tuning 18, upon closure and at the time of significant change in behavior or functional level:
a. Arizona Level of Functioning Assessment (ALFA)
b. Service Level Check Guidelines
c. Client Assessment Form Revised 10-01-01 Final Jun 7-01 Effective 7-01-01 Page 7 of 10
Member Assessment. 5.1.1 Initial Screening
EXHIBIT 1. M SCOPE OF WORK Based on the results of the initial screening, the Contractor shall stratify members into the appropriate service category - those members requiring disease management, care management, complex case management, or RCP, in accordance with Section 5.2. After stratifying the member to an appropriate care level, the Contractor shall provide ongoing disease management, care management, or complex case management, as appropriate. In addition to the initial screening conducted by the Contractor, the Contractor shall also develop strategies to encourage the contracted provider network to utilize screening tools to identify at-risk members. These provider-driven tools shall not duplicate or replace the Contractor conducted screenings. Respondents shall describe proposed strategies to facilitate implementation of provider-driven screening tools including methods to encourage usage, processes to communicate results to the Contractor and the proposed tool(s).
Member Assessment
