Integrated Care Management Program Sample Clauses

Integrated Care Management Program. (ICMP) a. The Contractor shall operate an enhanced care management program known as the Integrated Care Management Program (ICMP) for Enrollees with complex medical, mental health and/or substance use disorders. b. The Contractor shall also identify pregnant and postpartum Enrollees with the following high-risk conditions for outreach and engagement in the ICMP: 1) any history of complex or severe Behavioral Health diagnosis; 2) any history of substance use disorder, including opioids, alcohol, tobacco, or other substances; 3) any current chronic physical health diagnosis which may complicate pregnancy or postpartum (i.e., hypertension, diabetes, HIV, etc.); 4) any history of adverse maternal or neonatal outcomes in previous pregnancies, including any instances of severe maternal morbidity; and/or 5) any current complex social conditions which could impact outcomes during pregnancy or postpartum (i.e., unsafe living environment, significantly late prenatal care initiation, food or housing insecurity, etc.). c. The Contractor shall identify Enrollees for outreach and engagement in the ICMP through predictive modeling using Behavioral Health, Medical and Pharmacy claim data (historical and current), acceptance of referrals from PCCs, EOHHS staff, Enrollees or other providers for participation in the ICMP, and communication with Enrollees and Providers about ICMP. d. The Contractor shall provide monthly reports as further specified by EOHHS for Enrollees identified by the Contractor as eligible for ICMP, as well as the methodology by which these members are identified. e. For each Enrollee in the ICMP, the Contractor shall: 1) Provide Care Management (which are clinical care related services rendered to the member directly either in person or via telephone as per the individual care plan) and Care Coordination (which are care activities rendered by the Contractor on behalf of the Enrollee) to identified Enrollees who have complex medical or Behavioral Health needs and whose overall health care may benefit from the assistance of a Care Manager. 2) provide holistic coordinated health care, social supports, and wellness and recovery tools, and shall assist Enrollees with identifying and using their medical home for treatment of Behavioral Health and medical conditions.