Care Management Services means (i) providing LHA Services including health assessments, identification of risks, initiation of intervention and health education deemed Medically Necessary, consultation, referral for consultation and additional health care services; (ii) coordinating Medically Necessary Covered Services with other Medi- Cal benefits not covered under this Contract; (iii) maintaining a Medical Record with documentation of referral services, and follow-up as medically indicated; (iv) ordering of therapy, admission to hospitals and coordinated hospital discharge planning that includes necessary post-discharge care; (v) participating in disease management programs as applicable (vi) coordinating a Member’s care with all outside agencies pertinent to their needs as addressed in the MOUs and CalOptima Policies (vii) coordinating care for Members transitioning from CalOptima Direct to a Health Network.
Care Management Services means the business of providing utilization review (which includes, but is not limited to, pre-admission certification, prior authorization, prospective length of stay approvals, second opinions, concurrent review and discharge planning), catastrophic medical case management, disease management and demand (24 hours a day, 7 days a week) management services to benefits payors and health care providers, including third party administrators, provider organizations such as independent professional associations and provider management companies.
Care Management Services means the delegation by the MCO of the process that assesses the need for and assists enrollees in a managed long term care plan to access necessary covered services as identified in the Care Plan. It also provides referral and coordination of other services in support of the Care Plan. Care Management Services assists enrollees to obtain needed medical, social, educational, psychosocial, financial and other services in support of the Care Plan irrespective of whether the needed services are covered under the capitation payment to the MCO.
Examples of Care Management Services in a sentence
CalOptima shall offer its assistance for Care Management Services for Members through its Care Management Department.
More Definitions of Care Management Services
Care Management Services means the delegation by the MCO of the process that assists enrollees to access necessary covered services as identified in the Care Plan. It also provides referral and coordination of other services in support of the Care Plan. Care Management Services assists Enrollees to obtain needed medical, social, educational, psychosocial, financial and other services in support of the Care Plan irrespective of whether the needed services are covered under the capitation payment to the MCO. “Care Plan/Person Centered Service Plan” is a written description in the care management record of member-specific health care goals to be achieved and the amount, duration and scope of the covered services to be provided to an Enrollee in order to achieve such goals. The person centered individual service plan is based on assessment of the member's health care needs and developed in consultation with the member and his/her informal supports. The plan includes consideration of the current and unique psycho-social and medical needs and history of the enrollee, as well as the person’s functional level and support systems. Effectiveness of the person centered service plan is monitored through reassessment and a determination as to whether the health care goals are being met. Non-covered services which interrelate with the covered services identified on the plan and services of informal supports necessary to support the health care goals and effectiveness of the covered services should be clearly identified on the person centered service plan or elsewhere in the care management record.
Care Management Services shall be consistent with and not extend beyond the scope of the terms “Treatment” and “Limited Health Care Operations” as defined herein. Central Data Services -- means a repository and database(s) that are provided and maintained by CRISP and associated with each Participant’s system, which will hold a copy of all data, including Protected Health Information of each Participant which is available through the Health Information Exchange. The Central Data Services shall contain metadata which will allow each Participant to have control over its own data in the Central Data Services and effectively retain custody and control of its own data maintained in the Central Data Services as specified in Section 2(a)(i) of the Terms and Conditions (Attachment A/HC). Clinically Integrated Network – means a group of doctors, hospitals, and other Health Care Providers who come together voluntarily to give coordinated care to their Patients. The goal of a Clinically Integrated Network is to evaluate and modify practice patterns by Participants, and to create a high degree of interdependence and cooperation among Participants to control costs and enhance quality. Clinical Messaging -- means the exchange of Protected Health Information from one Participating Organization to another through the WVHIN in the form of test results or other clinical information. Test results can be generated by clinical laboratories, imaging providers, and other like providers. Other clinical information may consist of discharge summaries, consultation reports, and Patient referral data. For purposes of the WVHIN’s Health Information Exchange, Clinical Messaging is a point-to-point transaction. Consent -- means the decision of a Patient to participate in the WVHIN’s Health Information Exchange. No affirmative action is required from a Patient to establish his or her Consent. A Patient shall be deemed to have given his or her Consent to participate until and unless the Patient affirmatively Opts-Out of the Health Information Exchange.
Care Management Services means the designation by the managed care organization (MCO) of the process that assists enrollees to access necessary covered services as described in the MCO’s care plan.
Care Management Services means (i) providing LHA Services including health assessments, identification of risks, initiation of intervention and health education deemed Medically Necessary, consultation, referral for consultation and additional health care services; (ii) coordinating Medically Necessary Covered Services with other Medi• Cal benefits not covered under this Contract; (iii) maintaining a Medical Record with documentation ofreferral services, and follow-up as medically indicated; (iv) ordering of therapy, admission to hospitals and coordinated hospital discharge planning that includes Orange County Health Care Agency- Public Health Coordination and Provision of Public Health Care Services Contract Medi-Cal June I, 2013 necessary post-discharge care; (v) participating in disease management programs as applicable (vi) coordinating a Member's care with all outside agencies pertinent to their needs as addressed in the MOUs and CalOptima Policies (vii) coordinating care for Members transitioning from CalOptima Direct to a Health Network.
Care Management Services means a nurse-based program of care managed designed to promote the health of the patient while reducing the associated costs of treatment by focusing of active management of preventive health measures that will result in less frequent hospitalizations.
Care Management Services shall have the meaning as set forth in Section II.A.6.
Care Management Services means the delegation by the MCO of the process that assists enrollees to access necessary covered services as identified in the Care Plan.