PQ041 CCMP Policies-And-Procedures Program Evaluation TEMPLATE

Bayou Health Reporting

Report Information

Document ID:PQ041

Document Name:CCMP Policies and Procedures

(Program Evaluation)

Revision Date: 10/23/2017

Reporting Frequency:Annual

Deliverable Type: Text Document

Report Due Date:March 30th

Subject Matter:Quality

Document Type: Free FormTemplate

Information to be completed by the Health Plan

Health Plan ID:[Health Plan ID]

Health Plan Name:[Health Plan Name]

Health Plan Contact:[Contact Person's Name]

Health Plan Contact Email:[Contact Email]

Report Period Start Date:[Start Date]

Report Period End Date: [End Date]

Date Completed: [Today's Date]

Date Meeting Occurred: [xx/xx/xxxx]

Submission Date: [xx/xx/xxxx]

(This plan can be submitted in any format. However, this document must be completed and submitted with the required plan)

Definitions and Instructions:

Chronic Care Management Program Policies and Procedures

The plan shall submit Chronic Care Management Program policies and procedures to LDH for approval within thirty (30) days of signing the Contract, annually and previous to any revisions. The plan shall develop and implement policies and procedures that:

• Include the definition of the target population;
• Include member identification strategies, i.e., through encounter data;
• Include evidence-based clinical guidelines that have been formally adopted by the QA/PI committee;
• Include guidelines for treatment plan development, as described in National Committee for Quality Assurance (NCQA) Disease Management program content, that provide the outline for all program activities and interventions;
• Include a written description of the stratification levels for each chronic condition, including member criteria and associated interventions;
• Include methods for informing and educating members and providers;
• Emphasize exacerbation and complication prevention utilizing evidence- based clinical practice guidelines and patient empowerment and activation strategies;
• Address co-morbidities through a whole-person approach;
• Identify members who require in-person case management services and a plan to meet this need;
• Coordinate CCMP activities for members also identified in the Case Management Program; and
• Include Program Evaluation requirements.

RFP Reference: Care Management Program (CCMP) 6.42.4