Member Assessment Initial Screening Sample Clauses

Member Assessment Initial Screening. In accordance with 42 CFR 438.208(b)(3), the Contractor shall conduct an initial screening of each member within ninety (90) calendar days of the effective date of enrollment to identify the member's immediate physical and/or behavioral health care needs. The Contractor must make subsequent attempts to conduct an initial screening of each member’s needs if the initial attempt to contact the member is unsuccessful. The Contractor shall make attempts to find a member’s current contact information if it is not included in the enrollment file. The initial screening will also determine the need for disease management, care management, complex case management, or RCP services as detailed in Section 3.8.2. The Contractor shall utilize the FSSA Health Needs Screening tool. During the initial screening, and periodically thereafter, the Contractor will review the member’s claims history, identify access or accommodation needs, language barriers, or other factors that might indicate that the member requires additional assistance. The initial screening shall also identify members who have complex or serious medical conditions that require an expedited appointment with an appropriate provider. The initial screening will ensure that members who are in ongoing treatment receive assistance in accessing appropriate care in order to avoid disruptions in services. The initial screening must include a full review of important relevant clinical information such as the provider’s assessment of conditions and the severity of illness, treatment history and outcomes, other diseases, illnesses, and health conditions as well as the member’s psychosocial, support, behavioral health and treatment needs. At minimum, the initial screening shall: ▪ Utilize claims data, health information exchange data, information gathered in the screening, medical records and other sources to ensure care coordination and management; ▪ Identify gaps in member’s care and facilitate communication to relevant providers, including the member’s PMP, if applicable; ▪ Identify immediate physical and/or behavioral health needs; ▪ Determine need for care coordination and management; ▪ Conduct comprehensive review of clinical history; ▪ Perform stratification based on initial assessment and historical claims data; ▪ Determine clinical, psychosocial, functional and financial needs with appropriate referrals to community-based organizations or MCE programs; EXHIBIT 1 SCOPE OF WORK – HOOSIER HEALTHWISE ▪ Gather infor...