Requirements for Care Coordination Sample Clauses

Requirements for Care Coordination. Level Two (2) 4.4.6.1 Based on the Comprehensive Needs Assessment, the CONTRACTOR shall assign Care Coordination level two (2), at a minimum, to Members with one of the following: 4.4.6.1.1 Co-morbid health conditions; 4.4.6.1.2 High emergency room use, defined as three (3) or more emergency room visits in thirty (30) days; 4.4.6.1.3 A mental health or substance abuse condition causing moderate functional impairment; 4.4.6.1.4 Requiring assistance with two (2) or more ADLs or IADLs living in the community at low risk; 4.4.6.1.5 Mild cognitive deficits requiring prompting or cues;

Requirements for Care Coordination. Xxxxx 0 4.4.4.1 Members in care coordination level 1 shall receive, at a minimum, the following care coordination: 4.4.4.1.1 HRA annually (according to the standards in Section 4.4.2 of this Agreement) to determine if a higher care coordination level is needed; and 4.4.4.1.2 Review of Claims and utilization data at least quarterly to determine if the Member is in need of a comprehensive needs assessment and potentially higher level of care coordination.

Requirements for Care Coordination. Xxxxx 0 4.4.7.1 Based on the comprehensive needs assessment, the CONTRACTOR shall assign to care coordination level 3, at a minimum, to Members with one the following: 4.4.7.1.1 Who are medically complex or fragile, as defined by the CONTRACTOR; 4.4.7.1.2 With excessive emergency room use (as defined by the CONTRACTOR); 4.4.7.1.3 With a mental health or substance abuse condition causing high functional impairment; 4.4.7.1.4 With untreated substance dependency based on the current DSM or other functional scale determined by the State; 4.4.7.1.5 Requiring assistance with two (2) ADLs or IADLs living in the community at medium to high risk; 4.4.7.1.6 With significant cognitive deficits; and/or 4.4.7.1.7 With contraindicated pharmaceutical use. 4.4.7.2 The CONTRACTOR shall assign a specific care coordinator to each Member in care coordination level 3. 4.4.7.3 Care coordinators for Members in car e co o r d i n at i o n level 3 shall provide and/or arrange for the following care coordination services: 4.4.7.3.1 Care coordination services listed in Sections 4.4.6.3.1-4.4.6.3.4 of this Agreement; 4.4.7.3.2 Semi-annual comprehensive needs assessment (according to the standards in Section 4.4.5 of this Agreement) to determine if the CCP is appropriate and determine if a lower level of care coordination is needed; 4.4.7.3.3 Quarterly in-person visits with the Member; and 4.4.7.3.4 Monthly telephonic contact with the Member.