Care Management Model for the Medicaid SSI Population Sample Clauses

Care Management Model for the Medicaid SSI Population. The Department will reimburse HMOs for the care management services (outlined in Article III. B.) outside of the regular capitation payment. The Department will continue to cover other care management activities as an administrative component of the capitation rate or as an integral and inseparable component of another Medicaid covered benefit, as appropriate. The Department has identified specific procedure codes to represent the Medicaid SSI care management benefit. HMOs will be required to use these procedure codes to identify SSI care management activities provided by the WICT and / or SSI care management staff. HMOs will be required to submit member-specific claims via encounter records for the SSI care management benefit. The HMO must maintain documentation for each member that supports the claimed services in their care management system.

Care Management Model for the Medicaid SSI Population. The goal of the Department’s Medicaid SSI program is to improve the health of its members and enhance quality of care while reducing health care costs. The Department’s vision is to collaborate with HMOs to develop a comprehensive, integrated care model; incorporating social, behavioral health, and medical needs for members. The Department excludes those SSI Medicaid members who have Medicare coverage (dual eligible) from the SSI Care Management requirements. The HMO is responsible for establishing a team-based care management model. The care structure and care management model must assure coordination and integration of all aspects of all SSI members’ health care needs. The HMO must also promote effective communication and shared decision-making between care management team and the member regarding the member’s care. Based on health conditions and social determinants of health, the HMO must stratify members into different care management needs groups which will include an Wisconsin Interdisciplinary Care Team (WICT) structure (Article III (B)(2)(b)) for members with the highest needs.

Care Management Model for the Medicaid SSI Population. HMOs must develop a comprehensive, integrated care model which incorporates social, behavioral health, and medical needs for members The HMO must coordinate all aspects of all SSI members’ health care needs. The HMO must also promote effective communication and shared decision-making between care management team and the member regarding the member’s care. Based on health conditions and social determinants of health, the HMO must stratify members into different care management needs groups which will include a Wisconsin Interdisciplinary Care Team (WICT) structure for members with the highest needs. SSI Medicaid members who have Medicare coverage (dual eligible) and are enrolled in and receive Medicare benefits from a Medicare Advantage Organization are exempt from the Care Management requirement. SSI HMOs must have a Dual Eligible Special Needs Plan (D-SNP) available under the same parent organization, in order to facilitate coordination of care between Medicare and Medicaid for dual eligible members. Care Management Model Characteristics The HMO will have flexibility in developing its own care model(s) but it must have the following characteristics: