Tailored Care Management ccc. Section IV.
Tailored Care Management with the exception of most Members in xxxxxx care/adoption assistance and former xxxxxx youth, must be defaulted to PIHP-based care management. The PIHP must assign each AMH+ and CMA providing Tailored Care Management a justifiably sized population that allows and incentivizes the AMH+ practice or CMA to substantially engage in the model.
Tailored Care Management x. In addition to the factors outlined in the Technical Specifications for Tailored Care Management Provider Assignment, the PIHP shall consider the following factors when assigning each Member to care management at an AMH+ practice or a CMA, or at the PIHP level:
Tailored Care Management xix. The PIHP must assign and must ensure that AMH+ practices and CMAs assign the Member to a care manager with appropriate qualifications and experience according to the Member’s needs within thirty (30) Calendar Days of PIHP enrollment.
Tailored Care Management a. Eligibility for Tailored Management Care is revised and restated follows:
Tailored Care Management. 2. The PIHP shall auto-enroll new members who obtain an Innovations Waiver slot after PIHP launch into Tailored Care Management if they are not already enrolled in Tailored Care Management. The PIHP shall send new Waiver enrollees information about Tailored Care Management and the option to opt out with the materials informing them of their Waiver slot.
Tailored Care Management incorporates results of SIS® screening and/or level of care determination tool, unless modified by the Department.
Tailored Care Management. The PIHP shall ensure that the organization providing Tailored Care Management completes the care management comprehensive assessment prior to the annual update, and in subsequent years, aligns the timing of the reassessment with the ISP annual update.
Tailored Care Management. 3. For Innovations Waiver enrollees, the PIHP shall ensure that results of the SIS® are shared with the member’s care manager in an electronic format to aid completion of the care management comprehensive assessment.
Tailored Care Management. 42 C.F.R. § 441.301(c)(1)(vi).
