Enrollee Stratification Clause Samples
The Enrollee Stratification clause establishes a framework for categorizing individuals enrolled in a program or plan into distinct groups based on specific criteria, such as age, health status, or risk factors. In practice, this clause outlines the methods and data used to assign enrollees to different strata, which may affect how services are delivered, monitored, or reimbursed. Its core function is to enable tailored management and analysis of enrollees, ensuring that interventions or resources can be appropriately targeted and outcomes can be more accurately measured across different population segments.
Enrollee Stratification. The assessment process consists of two main components for community- based LTSS and non-LTSS Enrollees: IHSs for Enrollees who are not eligible for LTSS, and CFNA for community-based Enrollees who are eligible for LTSS or who are otherwise determined to be high-risk (as described in Section 2.6.
Enrollee Stratification. The ICO will develop and implement a strategy that uses a combination of initial screenings, assessments, assessment tools, functional assessments, referrals, administrative claims data, etc. to help prioritize and determine the level of Care Coordination needed by each Enrollee.