Common use of Intensive Case Management Clause in Contracts

Intensive Case Management. a. Intensive case management is intended for highly recidivistic adults who have a severe and persistent mental illness. The service is intended to help enrollees remain in the community and avoid institutional care. Care criteria for this level of 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 team composition shall be expanded to include members selected specifically to assist with the special needs of this population. b. The Health Plan shall provide this service for all enrollees for whom it is determined to be medically necessary, to include any enrollee who meets the following criteria: (1) Has resided in a state mental health treatment facility for at least six (6) of the past thirty-six (36) months; (2) Resides in the community and has had two (2) or more admissions to a state mental health treatment facility in the past thirty-six (36) months; (3) Resides in the community and has had three (3) or more admissions to a crisis stabilization unit, short-term residential facility, inpatient psychiatric unit, or any combination of these facilities within the past twelve (12) months; or (4) 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 services are frequent and intense and focus on helping the enrollee attain skills and supports needed for independent living. Case management services are provided primarily in the enrollee’s residence and include community- based interventions. d. The Health Plan shall provide this service in the least restrictive setting with the goal of improving the enrollee’s level of functioning, and providing ample opportunities for rehabilitation, recovery, and self-sufficiency. Intensive case management services shall be accessible twenty-four (24) hours per day, seven (7) days per week. The Health Plan shall demonstrate adequate capacity to provide this service for the targeted population within the guidelines outlined.

Intensive Case Management. a. Intensive case management is intended for highly recidivistic adults who have a severe and persistent mental illness. The service is intended to help enrollees remain in the community and avoid institutional care. Care criteria for this level of 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 team composition shall be expanded to include members selected specifically to assist with the special needs of this population. b. The Health Plan shall provide this service for all enrollees for whom it is determined to be medically necessary, to include any enrollee who meets the following criteria: (1) Has resided in a state mental health treatment facility for at least six (6) of the past thirty-six (36) months; (2) Resides in the community and has had two (2) or more admissions to a state mental health treatment facility in the past thirty-six (36) months; (3) Resides in the community and has had three (3) or more admissions to a crisis stabilization unit, short-term residential facility, inpatient psychiatric unit, or any combination of these facilities within the past twelve (12) months; or (4) 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.. WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform Contract c. Intensive case management services are frequent and intense and focus on helping the enrollee attain skills and supports needed for independent living. Case management services are provided primarily in the enrollee’s residence and include community- community-based interventions. d. The Health Plan shall provide this service in the least restrictive setting with the goal of improving the enrollee’s level of functioning, and providing ample opportunities for rehabilitation, recovery, and self-sufficiency. Intensive case management services shall be accessible twenty-four (24) hours per day, seven (7) days per week. The Health Plan shall demonstrate adequate capacity to provide this service for the targeted population within the guidelines outlined.

Intensive Case Management. a. Intensive case management is intended for highly recidivistic adults who have a severe and persistent mental illness. The service is intended to help enrollees remain in the community and avoid institutional care. Care criteria for this level of 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 team composition shall be expanded to include members selected specifically to assist with the special needs of this population. b. The Health Plan shall provide this service for all enrollees for whom it is determined to be medically necessary, to include any enrollee who meets the following criteria: (1) Has resided in a state mental health treatment facility for at least six (6) of the past thirty-six (36) months; (2) Resides in the community and has had two (2) or more admissions to a state mental health treatment facility in the past thirty-six (36) months; (3) Resides in the community and has had three (3) or more admissions to a crisis stabilization unit, short-term residential facility, inpatient psychiatric unit, or any combination of these facilities within the past twelve (12) months; or (4) 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.. HealthEase of Florida, Inc. Medicaid HMO Non-Reform Contract c. Intensive case management services are frequent and intense and focus on helping the enrollee attain skills and supports needed for independent living. Case management services are provided primarily in the enrollee’s residence and include community- community-based interventions. d. The Health Plan shall provide this service in the least restrictive setting with the goal of improving the enrollee’s level of functioning, and providing ample opportunities for rehabilitation, recovery, and self-sufficiency. Intensive case management services shall be accessible twenty-four (24) hours per day, seven (7) days per week. The Health Plan shall demonstrate adequate capacity to provide this service for the targeted population within the guidelines outlined.