Common use of Case Management Programs Clause in Contracts

Case Management Programs. In accordance with 5101:3-26-03.1(A)(8), MCPs must offer and provide comprehensive case management services which coordinate and monitor the care of members with specific diagnoses, or who require high-cost and/or extensive services. The MCP’s comprehensive case management program must also include a Children with Special Health Care Needs component as specified below. i. Each MCP must inform all members and contracting providers of the MCP’s case management services. ii. Children with Special Health Care Needs (CSHCN): CSHCN are a particularly vulnerable population which often have chronic and complex medical health care conditions. In order to ensure compliance with the provisions of 42 CFR 438.208, each MCP must establish a CSHCN component as part of the MCP’s comprehensive case management program. The MCP must establish a process for the timely identification, completion of a comprehensive needs assessment, and providing appropriate and targeted case management services for any CSHCN. CSHCN are defined as children age 17 and under who are pregnant, and members under 21 years of age with one or more of the following: -Asthma -HIV/AIDS -A chronic physical, emotional or mental condition for which they are receiving treatment or counseling -Supplemental security income (SSI) for a health-related condition -A current letter of approval from the Bureau of Children with Medical Handicaps (BCMH), Ohio Department of Health iii. The MCP’s comprehensive case management program must include, at a minimum, the following components: a. Identification - The MCP must have a variety of mechanisms in place to identify members potentially eligible for case management. These mechanisms must include an administrative data review (e.g., diagnosis, cost threshold, and/or service utilization) and may include provider/self referrals, telephone interviews, information as reported by MCEC during membership selection, or home visits.

Case Management Programs. In accordance with 5101:3-26-03.1(A)(8), MCPs must offer and provide comprehensive case management services which coordinate and monitor the care of members with specific diagnoses, or who require high-cost and/or extensive services. The MCP’s 's comprehensive case management program must also include a Children with Special Health Care Needs component as specified below. i. Each MCP must inform all members and contracting providers of the MCP’s 's case management services. ii. Children with Special Health Care Needs (CSHCN): CSHCN are a particularly vulnerable population which often have chronic and complex medical health care conditions. In order to ensure compliance with the provisions of 42 CFR 438.208, each MCP must establish a CSHCN component as part of the MCP’s 's comprehensive case management program. The MCP must establish a process for the timely identification, completion of a comprehensive needs assessment, and providing appropriate and targeted case management services for any CSHCN. CSHCN are defined as children age 17 and under who are pregnant, and members under 21 years of age with one or more of the following: -Asthma -HIV/AIDS -A chronic physical, emotional or mental condition for which they are receiving treatment or counseling -Supplemental security income (SSI) for a health-related condition -A current letter of approval from the Bureau of Children with Medical Handicaps (BCMH), Ohio Department of Health iii. The MCP’s 's comprehensive case management program must include, at a minimum, the following components: a. Identification - The MCP must have a variety of mechanisms in place to identify members potentially eligible for case management. These mechanisms must include an administrative data review (e.g., diagnosis, cost threshold, and/or service utilization) and may include provider/self referrals, telephone interviews, information as reported by MCEC during membership selection, or home visits.