Common use of Stratification Clause in Contracts

Stratification. Based upon an analysis of the information gathered through the process in this section, Contractor shall stratify all Enrollees to determine the appropriate level of intervention by its Care Management program. Enrollees shall be assigned to one (1) of three (3) levels: Level 1 Includes low- or no-risk Enrollees to whom Contractor provides, at a minimum, prevention and wellness messaging and condition-specific education materials. Level 2 Includes moderate-risk Enrollees for whom Contractor provides problem-solving interventions. Level 3 Enrollees for whom Contractor provides intensive Care Management for reasons such as addressing acute and chronic health needs, behavioral health needs or addressing lack of social support. All Special-Needs Children are categorized as Level 3. 5.13.1.4.1 Contractor shall stratify Enrollee groups using the minimum requirements provided below: Minimum percentages of Enrollees Families and children population N/A 2% ACA expansion population N/A 2% Special-Needs Children (SSI, DSCC, Disabled) N/A 100% Seniors or Persons with Disabilities 20% 5% Dual-Eligible Adults 90% 20%