Common use of Care Plan Development Clause in Contracts

Care Plan Development. After the initial assessment and stratification, the Contractor shall assign members to a care level, develop a care plan for each member, and facilitate and coordinate the holistic care of each member according to his or her needs. The Contractor shall utilize a person-centered care plan development planning process, developed in accordance with any applicable State quality assurance and utilization review standards. The member or guardian must sign off on the care plan and the plan must be approved by the Contractor in a timely manner per 42 CFR 438.208(c)(3)(iii)-(v). All identified pregnant women who agree to either care management or complex case management shall have a care plan developed in conjunction with the Contractor. The Contractor will use data from multiple sources in the development of each member’s care plan, including, at minimum, claims data, data collected during the initial screening, the follow-up comprehensive health assessment, available medical records, clinical data from health information exchanges, Indiana Scheduled Prescription Electronic Collection & Tracking (INSPECT) and any other sources, to ensure that the care for members is adequately coordinated and appropriately managed. Through data analysis and predictive modeling, the Contractor will identify members who are at the highest risk for hospitalization or relapse, or high cost and/or high utilization in the future. In addition, the Contractor will gather information about the level and type of existing care and/or case management services that the member may already be receiving, for example, through a CMHC. The Contractor will use the information to identify gaps in the member’s current treatment approach, and communicate those findings to the member’s PMP (if applicable) or another appropriate physician.