CFSP 5 Year Plan - RI Department of Children, Youth & Families

A. Introduction/Purpose:
The goals of Neighborhood’s Care Management Programs are to assist members to
achieve optimum health and improved functional capability in an appropriate setting that
is cost-effective. The purpose of this procedure is to define Neighborhood’s standards for
assessment, documentation, ongoing monitoring, management, evaluation and case
closure criteria in support of this goal.
The Pediatric Case Management (CM) staff completes enrollment screens consisting of
initial health needs, Level I and Level II Assessments (when applicable) for any child or
adolescent that is newly enrolled in the CSN/Substitute Care lines of business. This
procedure will help to proactively identify medically necessary medical and behavioral
health service needs, access barriers, and to determine individual acuity level
B. Policy:
The CM staff use a consistent process to collect data on all new CSN and Substitute
members by completing the enrollment screening tool. The Initial Health Assessment
will be completed for every newly enrolled member into the CSN or Substitute Care
program.
For Substitute Care members (5100 and 5211), the DCYF Caseworker will be
notified of all referrals made to any NHPRI Care Management Programs.
COB indicates coordination of benefits. This is a provision establishing an order in
which plans pay their claims. Rite care is always considered secondary to all other
insurance plans therefore not eligible for Care Management Programs. CSN
members with COB are eligible for Care Management Programs.
C. Timelines:
• Initial Health Screens, must be completed within 45 days of enrollment into the
health plan.
• Level 1 Needs review and Short Term Care Coordination must be completed for
all indicated children within 30 days of completion of the initial health screen by
the Health plan.
• Level 2 Needs review and where indicated the ICM Plan must be completed
within 30 days of the Initial Health or Level 1 needs review assuming family
• Newly enrolled members in the CSN line of business may continue
to receive services from non participating practitioners with who
they have an established patient-physician relationship for up to
six (6) months following the date of enrollment.
D. Process:
The Pediatric Case Management staff uses a consistent care planning process that
involves / engages the member in the identification of goals and the interventions to
support those goals and achieve better health outcomes; monitors member progress
through interactive outreach, follow-up, and evaluation.
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