Common use of Intensive Case Management Clause in Contracts

Intensive Case Management. MANDATORY This service is intended to provide intensive team case management to highly recidivistic adults who have a severe and persistent mental illness. The service is intended to help recipients remain in the community and avoid institutional care. Clinical care criteria for this level of case management shall address the same elements required above, as well as expanded elements related to access and 24-hour coverage as described below. Additionally, the intensive case management team composition shall be expanded to include members of the team especially selected to assist with the special needs of this population. The provider shall include this in the description of how this service will be provided. The provider shall provide this service for all prepaid mental health plan enrollees for whom the service is determined to be medically necessary. Intensive case management provides services through the use of a team of case managers. The team can be expanded to include other specialists that are qualified to address identified needs of the recipients receiving the service. This level of care for case management is the most intensive and serves individuals with the most severe and disabling mental conditions. Services are frequent and intense with a focus on assisting the individual with attaining the skills and supports needed to gain independent living skills. Intensive case management services are provided primarily in the recipient’s residence and include community-based interventions. The provider shall provide this service in the least restrictive setting with the goal of improving the client’s level of functioning, and providing ample opportunities for rehabilitation, recovery, and self-sufficiency. Intensive targeted case management services shall be accessible 24 hours per day, 7 days per week. The provider shall demonstrate adequate capacity to provide this service for the targeted population within the guidelines outlined. Intensive case management teams shall provide the same coordination and case management services for recipients admitted to inpatient facilities, state mental hospitals, and forensic or corrections facilities as those listed above for mental health targeted case management services. The following performance measures shall be addressed in the provision of intensive case management: • Average number of days spent in the community by all prepaid mental health plan recipients receiving intensive case management services. • Number of prepaid mental health plan recipients admitted to the state mental hospital.

Intensive Case Management. MANDATORY This service a. Intensive Case Management is intended to provide intensive team case management Case Management to highly recidivistic adults who have a severe and persistent mental illness. The service is intended to help recipients Enrollees remain in the community and avoid institutional care. Clinical care criteria for this level of case management Case Management shall address the same elements required above, as well as expanded elements related to access and twenty-four (24-) hour coverage as described below. Additionally, the intensive case management Case Management team composition shall be expanded to include members of the team especially selected specifically to assist with the special needs of this population. The provider Health Plan shall include this the team composition and how it will assist with special needs in the description of how this service will be provided. . b. The provider Health Plan shall provide this service for all prepaid mental health plan enrollees Enrollees for whom the service is determined to be medically necessary. Medically Necessary, to include enrollees who meet the following criteria: · Has resided in a state mental health treatment facility for at least 6 months in the past 36 months; · Resides in the community and has had two or more admissions to a state mental health treatment facility in the past 36 months; · Resides in the community and has had three or more admissions to a crisis stabilization unit, short-term residential facility, inpatient psychiatric unit, or any combination of these facilities within the past 12 months; or · Resides in the community and, due to a mental illness, exhibits behavior or symptoms that could result in long-term hospitalization if frequent interventions for an extended period of time were not provided. c. Intensive case management Case Management provides services through the use of a team of case managers. The team can be expanded to include other specialists that are qualified to address identified needs of the recipients Enrollees receiving the serviceintensive Case Management. This level of care for case management Case Management is the most intensive and serves individuals Enrollees with the most severe and disabling mental conditions. Services are frequent and intense with a focus on assisting the individual Enrollee with attaining the skills and supports needed to gain independent living skills. Intensive case management Case Management services are provided primarily in the recipientEnrollee’s residence and include community-based interventions. . d. The provider Health Plan shall provide this service in the least restrictive setting with the goal of improving the clientEnrollee’s level of functioning, and providing ample opportunities for rehabilitation, recovery, and self-sufficiency. Intensive targeted case management Case Management services shall be accessible 24 twenty-four (24) hours per day, 7 seven (7) days per week. The provider Health Plan shall demonstrate adequate capacity to provide this service for the targeted population within the guidelines outlined. . e. Intensive case management Case Management teams shall provide the same coordination and case management Case Management services for recipients Enrollees admitted to inpatient facilities, state State mental hospitalsHospitals, and forensic or corrections facilities as those listed above for mental health targeted case management services. The following performance measures shall be addressed in the provision of intensive case management: • Average number of days spent in the community by all prepaid mental health plan recipients receiving intensive case management services. • Number of prepaid mental health plan recipients admitted to the state mental hospital.