Common use of Target Populations Clause in Contracts

Target Populations. (1) Behavioral health targeted case management services shall be available to all enrollees: (a) Who require numerous services from different providers and also require advocacy and coordination to implement or access services; (b) Who would be unable to access or maintain consistent care within the service delivery system without case management services; (c) Who do not possess the strengths, skills, or support system to allow them to access or coordinate services; (d) Who may benefit from case management but lack the skills or knowledge necessary to access services; or (e) Who do not meet these criteria but may still be eligible for limited targeted case management services by meeting exception criteria contained in the Medicaid Targeted Case Management Coverage and Limitations Handbook. (2) The Health Plan also shall have case management services available to children/adolescents who have a serious emotional disturbance, which is: a defined mental disorder; a level of functioning which requires two or more coordinated behavioral health services to be able to live in the community; and at imminent risk of out-of-home behavioral health treatment placement. (3) The Health Plan shall also have case management services available for adults with a severe and persistent mental illness or who have been denied admission to a long-term mental health institution or residential treatment facility or have been discharged from a long-term mental health institution or residential treatment facility. WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform Contract

Target Populations. (1) Behavioral health targeted case management services shall be available to all enrollees: (a) Who require numerous services from different providers and also require advocacy and coordination to implement or access services; (b) Who would be unable to access or maintain consistent care within the service delivery system without case management services; (c) Who do not possess the strengths, skills, or support system to allow them to access or coordinate services; (d) Who may benefit from case management but lack the skills or knowledge necessary to access services; or (e) Who do not meet these criteria but may still be eligible for limited targeted case management services by meeting exception criteria contained in the Medicaid Targeted Case Management Coverage and Limitations Handbook. (2) The Health Plan also shall have case management services available to children/adolescents who have a serious emotional disturbance, which is: a defined mental disorder; a level of functioning which requires two or more coordinated behavioral health services to be able to live in the community; and at imminent risk of out-of-home behavioral health treatment placement. (3) The Health Plan shall also have case management services available for adults with a severe and persistent mental illness or who have been denied admission to a long-term mental health institution or residential treatment facility or have been discharged from a long-term mental health institution or residential treatment facility. WellCare HealthEase of Florida, Inc. d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform Contract