Care Management Plan Clause Samples
Care Management Plan. A Care Management Plan to identify and address how the Participant’s physical, cognitive, and behavioral healthcare needs will be care managed, including: • Active chronic problems, current non-chronic problems, cognitive needs, and problems that were previously controlled or classified as maintenance care but have been exacerbated by disease progression or other intervening conditions. • Current medications. • All services authorized and the scope, amount, duration and frequency of the services authorized, including any services that were authorized by the CHC- MCO since the last PCSP was finalized that need to be authorized moving forward. • A schedule of preventive service needs or requirements. • Disease Management action steps. • Known needed physical and behavioral healthcare and services. • All designated points of contact and the Participant’s authorizations of who may request and receive information about the Participant’s services. • How the Service Coordinator will assist the Participant in accessing Services identified in the PCSP. • How the CHC-MCO will coordinate with the Participant’s Medicare, Veterans, BH-MCO, and other health insurers and other supports.
Care Management Plan i. Within thirty (30) Business Days of execution of this Amendment, the PHP shall develop and submit to the Department a COVID-19 Care Management Plan.
a. The COVID-19 Care Management Plan shall address how the PHP intends to use its care management processes and staff, either internal or contracted, to support COVID-19 response activities during the term of this Amendment.
b. The Care Management Plan shall describe:
a. How care management activities will be performed (e.g., virtual vs. in person) and how care management processes will be changed (e.g., changes to identification/outreach, new triggers for engagement, changes to Care Needs Screenings/Comprehensive Assessments/Care Plans, etc.);
b. How the PHP will conduct outreach to and alter care management processes for select populations that are at high-risk of contracting or high-risk of complications associated with COVID-19;
c. How the PHP will educate and train care managers in a manner that is aligned with Federal and/or State guidance, and collaborate with contracted delegated care management entities, including Tier 3 Advanced Medical Homes (Tier 3 AMHs) and Local Health Departments (LHDs) on the COVID-19 response;
d. How the PHP will provide care managers with information on Members impacted by COVID-19; and
e. How PHPs will connect care managers with information on testing, contact tracing, support services, vaccine administration and other aspects of the public health response to COVID-19 that aligns with Federal and/or State guidance to share with Members.
ii. The Care Management Plan shall describe Long-Term Services and Supports-specific (LTSS) care management provisions, including:
a. How the PHP will ensure that Members using LTSS who are engaged in care management are receiving no less than the number of care management contacts typically provided outside of the COVID-19 response;
b. Innovative approaches to communicate with Members using LTSS and their families or authorized representatives;
c. Strategies to address barriers to community transitions related to transportation and housing; and
d. Approach for addressing the unique needs of different populations (e.g., Members in nursing homes, Members using home health or personal care services).
iii. The PHP shall include within its COVID-19 Care Management Plan a timeline for implementation of efforts.
Care Management Plan. A Care Management Plan to identify and address how LTSS Participants’ physical, cognitive, and behavioral healthcare needs will be care managed, including:
Care Management Plan. A Care Management Plan to identify and address how the Participant’s physical, cognitive, and behavioral healthcare needs will be care managed, including: • Active chronic problems, current non-chronic problems, cognitive needs, and problems that were previously controlled or classified as maintenance care but have been exacerbated by disease progression or other intervening conditions. • Current medications. • All services authorized and the scope and duration of the services authorized, including any services that were authorized by the CHC- MCO since the last PCSP was finalized that need to be authorized moving forward. • A schedule of preventive service needs or requirements. • Disease Management action steps. • Known needed physical and behavioral healthcare and services. • All designated points of contact and the Participant’s authorizations of who may request and receive information about the Participant’s services. • How the Service Coordinator will assist the Participant in accessing Services identified in the PCSP. • How the CHC-MCO will coordinate with the Participant’s Medicare, Veterans, BH-MCO, and other health insurers and other supports.
Care Management Plan. A written plan that is developed with input from the Member and/or their family member(s), parent, legal guardian, authorized representative, caregiver, and/or other authorized support person(s) as appropriate to assess strengths, risks, needs, goals, and preferences, and make recommendations for clinical and non-clinical service needs.