Care Management Services. The MCO shall be responsible for the Care Management of all Enrollees. The MCO’s Care Management system must be designed to coordinate the provision of primary care and all other Covered Services to its Enrollees and must promote and assure service accessibility, attention to individual needs, continuity of care, comprehensive and coordinated service delivery, the provision of culturally appropriate care, and fiscal and professional accountability. At a minimum, the MCO’s Care Management system must incorporate the following elements:
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Care Management Services. CalOptima shall offer its assistance for Care Management Services for Members through its Care Management Department.
Care Management Services. Member information shall be maintained by Contractor and accessible twenty-four
Care Management Services. Member information shall be maintained by the Contractor and accessible twenty- four (24) hours per day seven (7) days per week by members of the Care Management Team. The Contractor must develop and adopt policies and procedures to ensure all Members have access to required services. At a minimum, Members shall have available the following services:
Care Management Services. As part of this Agreement and under the terms indicated in the addendum “Schedule ‘A’”, the Parties agree that HPI or its affiliates or designees (the “Care Management Service Provider” or “CMS”) shall provide utilization review and case management services and other related services as follows:
Care Management Services. Network will make available, as necessary, the services of licensed professional(s) and support staff to perform chronic care management services on behalf of Group with respect to Group patient/members who are identified by Group as eligible for CCM Services. The elements of CCM Services to be provided by Network or Group are identified on Schedule 1 attached hereto and incorporated herein by this reference. Network's licensed professionals shall be known as “Care Managers,” and together with support staff, shall be known as the “Care Management Team.” Decisions regarding the qualifications, numbers and types of individuals comprising the Care Management Team needed to fulfill Network's responsibilities hereunder will be made within the reasonable discretion of Network. The Care Management Team will report to and conduct care management services under the supervision of a Group physician and also under the direction of the Network's Director of Care Management. The Group's Medical Director will act as a clinical resource to and provide medical direction for the Care Management Team working with Group patients. Network shall cooperate with Group personnel and consult with the Group physicians and other professionals, when appropriate, to ensure high quality patient care.
Care Management Services. 20 . When Your Claim is Paid................................................ 20 . How Claims are Paid.................................................... 21 . Our Rights to Obtain Information....................................... 21 .
Care Management Services. 1. The PHP shall provide care management, according to the Care Plan developed, to each high-need Member or through a contracted AMH, consistent with local care management requirements.
Care Management Services. ECI shall provide or arrange for the provision of Care Management Services, as set forth below, to Enrollees who become Program Participants, and in coordination with the respective primary care and/or treating physicians of the Program Participants. The Care Management Service provided by ECI is a nurse-based program that supports the services provided by health care providers with individual Care Management for chronically ill patients. The objective of the program is to reduce the incidence of hospitalization among patients with some combination of congestive heart failure, diabetes, respiratory disease, or other illnesses, through individual monitoring, behavioral modification and preventive health measures. ECI nursing personnel receive special training in accordance with the confidential and proprietary training materials contained in the ECI Professional Training Manual. ECI will staff the Care Management Program with one full-time equivalent for each one hundred (100) Program Participants, plus a number of support staff both within the community and at the ECI central office. The Care Management Nurse will meet with each Program Participant on an intermittent basis ranging from daily to bimonthly, and will record pertinent information utilizing a confidential and proprietary Patient Information System operating upon a hand-held computer. The Care Management Services also include weekly physical therapy/recreational group sessions with each Program Participant during which the Care Management Nurse will be assisted by physical therapists, nursing assistants and/or other staff. Program Participants will be selected for participation in the Care Management Program based upon criteria assessed using the confidential and proprietary Selection Criteria developed by ECI and approved by ALERE. Where services are delivered in the home and community centers, ECI provides the following:
