Risk Stratification 314 Clause Samples

Risk Stratification 314. 2.6.1.1. The STAR+PLUS MMP will develop and implement a risk stratification process that uses a combination of predictive-modeling software, assessment tools, referrals, administrative Claims data, and other sources of information as appropriate that will consider Enrollees’ physical and behavioral health, substance use, and LTSS needs and specifically, any Special Health Care Needs of the Enrollees. 314 2.6.1.2. The STAR+PLUS MMP will stratify Enrollees in two (2) risk levels, with level 1 the highest risk and level 2 moderate and lower risk Enrollees. 314 2.6.1.2.1. These levels of stratification should be based on: 314 2.6.1.2.1.1. Level 1 Enrollees: Highest level of risk/utilization includes HCBS STAR+PLUS Waiver, Nursing Facility, individuals with SPMI, and other Enrollees with complex medical needs. 314