40 Case Management Policies and Procedures Program Evaluation

Bayou Health Reporting

Report Information

Document ID:40

Document Name:Case ManagementPolicies and Procedures

Revision Date: 9/28/2017

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:

Case Management Policies and Procedures

The Health Plan shall submit Case Management Program policies and procedures to DHH for approval within thirty (30) days from the date the Contract is signed by the Health Plan, annually and previous to any revisions. Case Management policies and procedures shall include, at a minimum, the following elements:

-A process to offer voluntary participation in the Case Management Program to eligible members;

-Identification criteria, process, and triggers for referral and admission into the Case Management Program;

-Identification criteria, process, and triggers for referral and admission into a Perinatal Case Management Program which should include, but not be limited to, the following:

• Reproductive aged women with a history of prior poor birth outcomes; and
• High risk pregnant women.

-The provision of an individual needs assessment and diagnostic assessment; the development of an individual plan of care and treatment care plan, as necessary, based on the needs assessment; the establishment of short and long term treatment objectives; the monitoring of outcomes; and a process to ensure that treatment care plans are revised as necessary. These procedures shall be designed to accommodate the specific cultural and linguistic needs of the Health Plan’s members; Procedures must describe collaboration processes with member’s treatment providers;

-A strategy to ensure that all members and/or authorized family members or guardians are involved in treatment care planning;

-Procedures and criteria for making referrals to specialists and subspecialists;

-Procedures and criteria for maintaining care plans and referral services when the member changes PCPsand behavioral health providers; and

-Coordinate Case Management activities for members also receiving services through the Health Plan’s Chronic Care Management Program.

RFP Reference: Case Management 6.40