Care Plan Development. After the initial assessment and stratification, the Contractor shall assign members to a care level, develop a care plan for each member, and facilitate and coordinate the holistic care of each member according to his or her needs. The Contractor shall utilize a person-centered care plan development planning process, developed in accordance with any applicable State quality assurance and utilization review standards. The member or guardian must sign off on the care plan and the plan must be approved by the Contractor in a timely manner per 42 CFR 438.208(c)(3)(iii) -(v). All identified pregnant women who agree to either care management or complex case management shall have a care plan developed in conjunction with the Contractor. The Contractor will use data from multiple sources in the development of each member’s care plan, including, at minimum, claims data, data collected during the initial screening, the follow-up comprehensive health assessment, available medical records, clinical data from health information exchanges, Indiana Scheduled Prescription Electronic Collection & Tracking (INSPECT) and any other sources, to ensure that the care for members is adequately coordinated and appropriately managed. Through data analysis and predictive modeling, the Contractor will identify members who are at the highest risk for hospitalization or relapse, or high cost and/or high utilization in the future. In addition, the Contractor will gather information about the level and type of existing care and/or case management services that the member may already be receiving, for example, through a CMHC. The Contractor will use the information to identify gaps in the member’s current treatment approach and communicate those findings to the member’s PMP (if applicable) or another appropriate physician. The Contractor will assist the member, the member’s family and the member’s physician(s) to develop a care plan with specific objectives, goals and action protocols to meet identified needs. The Contractor will initiate and facilitate specific activities, interventions and protocols that lead to accomplishing the goals set forth in the care plan and shall be responsible for developing strategies to facilitate timely and secure communication and information sharing between providers, caregivers, and stakeholders. The care plan will include, at a minimum: ▪ Clinical history and pertinent family history; ▪ Diagnosis(es); ▪ Functional and/or cognitive status; ▪ Medical Equ...
Care Plan Development. After the initial assessment and stratification, the Contractor shall assign members to a care level, develop a care plan for each member, and facilitate and coordinate the holistic care of each member according to his or her needs. The Contractor shall utilize a person-centered care plan development planning process. The Contractor will use data from multiple sources in the development of each member’s care plan, including, at minimum, claims data, data collected during the initial screening, the follow-up comprehensive health assessment, available medical records, Indiana Scheduled Prescription Electronic Collection & Tracking (INSPECT) and any other sources, to ensure that the care for members is adequately coordinated and appropriately managed. Through data analysis and predictive modeling, the Contractor will identify members who are at the highest risk for hospitalization or relapse, or high cost and/or high utilization in the future. In addition, the Contractor will gather information about the level and type of existing care and/or case management services that the member may already be receiving, for example, through a CMHC. The Contractor will use the information to identify gaps in the member’s current treatment approach, and communicate those findings to the member’s PMP (if applicable) or other appropriate physician. The Contractor will assist the member, the member’s family and the member’s physician(s) to develop a care plan with specific objectives, goals and action protocols to meet identified needs. In the case of wards, xxxxxx children and former xxxxxx children, the Contractor will also collaborate with Indiana DCS, stakeholders such as community-based service providers, the judicial system, advocates, physical and behavioral health providers, caregivers (including adoptive family or biological family as appropriate) and schools through Individual Education Plans (IEP), in the development of the care plan. The Contractor will initiate and facilitate specific activities, interventions and protocols that lead to accomplishing the goals set forth in the care plan, and shall be responsible for developing strategies to facilitate timely and secure communication and information sharing between providers, caregivers, and stakeholders. The care plan will include, at a minimum: Clinical history; Diagnosis(es); Functional and/or cognitive status; Immediate service needs; Use of services not covered by the program; Accommodation needs ...
Care Plan Development. As part of the Comprehensive Care Plan development, the care management team or the WICT, in coordination with the member, must create an evidence-based plan of care that includes:
Care Plan Development. As part of the Comprehensive Care Plan development, the care management team or the WICT, in coordination with the member, must create an evidence-based plan of care that includes: • Specific goals appropriate for the member’s needs, • The member’s readiness to self-manage their care and their willingness to adopt healthy behaviors, • A description of the interventions that will be implemented to address the member’s needs and their sequence. The care management team or the WICT must: • Develop the Comprehensive Care Plan with the member (either face-to-face, via interactive video (synchronous telehealth) or over the phone) and obtain member’s agreement prior to its implementation. • Upon completion, share the Comprehensive Care Plan with the member, the member’s primary care provider and others as identified, as appropriate, in the care plan and discussed with member. • Document the Comprehensive Care Plan, preferably according to the specifications for Care Plans in the ONC Interoperability Standards Advisory.
Care Plan Development. After the initial assessment and stratification, the Contractor shall assign members to a care level, develop a care plan for each member, and facilitate and coordinate the holistic care of each member according to his or her needs. The Contractor shall utilize a person-centered care plan development planning process, developed in accordance with any applicable State quality assurance and utilization review standards. The member or guardian must sign off on the care plan and the plan must be approved by the Contractor in a timely manner per 42 CFR 438.208(c)(3)(iii)-(v). All identified pregnant women who agree to either care management or complex case management shall have a care plan developed in conjunction with the Contractor. The Contractor will use data from multiple sources in the development of each member’s care plan, including, at minimum, claims data, data collected during the initial screening, the follow-up comprehensive health assessment, available medical records, clinical data from health information exchanges, Indiana Scheduled Prescription Electronic Collection & Tracking (INSPECT) and any other sources, to ensure that the care for members is adequately coordinated and appropriately managed. Through data analysis and predictive EXHIBIT 1 SCOPE OF WORK – HOOSIER HEALTHWISE modeling, the Contractor will identify members who are at the highest risk for hospitalization or relapse, or high cost and/or high utilization in the future. In addition, the Contractor will gather information about the level and type of existing care and/or case management services that the member may already be receiving, for example, through a CMHC. The Contractor will use the information to identify gaps in the member’s current treatment approach, and communicate those findings to the member’s PMP (if applicable) or another appropriate physician. The Contractor will assist the member, the member’s family and the member’s physician(s) to develop a care plan with specific objectives, goals and action protocols to meet identified needs. The Contractor will initiate and facilitate specific activities, interventions and protocols that lead to accomplishing the goals set forth in the care plan, and shall be responsible for developing strategies to facilitate timely and secure communication and information sharing between providers, caregivers, and stakeholders. The care plan will include, at a minimum: ▪ Clinical history and pertinent family history; ▪ Diagnosis(es); ▪ Fun...
Care Plan Development. After the initial assessment and stratification, the Contractor shall assign members to a care level, develop a care plan for each member, and facilitate and coordinate the holistic care of each member according to his or her needs. The Contractor shall utilize a person-centered care plan development planning process, developed in accordance with any applicable State quality assurance and utilization review standards, and the plan must be approved by the Contractor in a timely manner per 42 CFR 438.208(c)(3)(iii)-(v). All identified pregnant women who agree to either care management or complex case management shall have a care plan developed in conjunction with the Contractor. The Contractor will use data from multiple sources in the development of each member’s care plan, including, at minimum, claims data, data collected during the initial screening, the follow-up comprehensive health assessment, available medical records, clinical data from health information exchanges, Indiana Scheduled Prescription Electronic Collection & Tracking (INSPECT) and any other sources, to ensure that the care for members is adequately coordinated and appropriately managed. Through data analysis and predictive modeling, the Contractor will identify members who are at the highest risk for hospitalization or relapse, or high cost and/ or high utilization in the future. In addition, the Contractor will gather information about the level and type of existing care and/or case management services that the member may already be receiving, for example, through a CMHC. The Contractor will use the information to identify gaps in the member’s current treatment approach, and communicate those findings to the member’s PMP (if applicable) or another appropriate physician. The Contractor will assist the member, the member’s family and the member’s physician(s) to develop a care plan with specific objectives, goals and action protocols to meet identified needs. In the case of wards, xxxxxx children and former xxxxxx children, the Contractor will also collaborate with Indiana DCS, stakeholders such as community-based service providers, the judicial system, advocates, physical and behavioral health providers, caregivers (including adoptive family or biological family as appropriate) and schools through Individual Education Plans (IEP), in the development of the care plan. The Contractor will initiate and facilitate specific activities, interventions and protocols that lead to accomplishing th...
Care Plan Development. After the initial assessment and stratification, the Contractor shall assign members to a care level, develop a care plan for each member, and facilitate and coordinate the holistic care of each member according to his or her needs. The Contractor shall utilize a person-centered care plan development planning process, developed in accordance with any applicable State quality assurance and utilization review standards. The member or guardian must sign off on the care plan and the plan must be approved by the Contractor in a timely manner per 42 CFR 438.208(c)(3)(iii)-(v). All identified pregnant women who agree to either care management or complex case management shall have a care plan developed in conjunction with the Contractor. EXHIBIT 1
Care Plan Development. After the initial assessment and stratification, the Contractor shall assign members to a care level, develop a care plan for each member, and facilitate and coordinate the holistic care of each member according to his or her needs. The Contractor shall utilize a person-centered care plan development planning process.
