Common use of CARE COORDINATION AND CASE MANAGEMENT Clause in Contracts

CARE COORDINATION AND CASE MANAGEMENT. 5.1 General Care Coordination and Case Management Requirements As part of the Care Coordination and Case Management System, the CONTRACTOR shall be responsible for the management, coordination, and Continuity of Care for all its Members and shall develop and maintain Policies and Procedures to address this responsibility. The CONTRACTOR’s Care Coordination activities and Case Management Program shall be based on sound evidence and conform to the requirements and industry standards stipulated in the NCQA requirements for Complex Case Management and by the Standards of Practice of Case Management released by the Case Management Society of America (CMSA). The CONTRACTOR shall: 5.1.1 Make a best effort to conduct an initial screen of each Enrollee’s needs, within ninety (90) Days of the effective date of Enrollment for all new Enrollees, including subsequent attempts if the initial attempt to contact the Enrollee is unsuccessful. (42 CFR § 438.208(b)(3))

CARE COORDINATION AND CASE MANAGEMENT. 5.1 General Care Coordination and Case Management Requirements As part of the Care Coordination and Case Management System, the CONTRACTOR shall be responsible for the management, coordination, and Continuity of Care for all its Members and shall develop and maintain Policies and Procedures to address this responsibility. The CONTRACTOR’s Care Coordination activities and Case Management Program shall be based on sound evidence and conform to the requirements and industry standards stipulated in the NCQA requirements for Complex Case Management and by the Standards of Practice of Case Management released by the Case Management Society of America (CMSA). The CONTRACTOR shall: 5.1.1 Make a best effort to conduct an initial screen of each EnrolleeMember’s needs, within ninety (90) Days days of the effective date of Enrollment for all new EnrolleesMembers, including subsequent attempts if the initial attempt to contact the Enrollee Member is unsuccessful. (42 CFR § 438.208(b)(3))