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

2) Care Managers use the following case closure criteria to identify those members
who are no longer in need of complex case management services:
a) Short-term and long-term goals are met
b) Member has achieved his or her maximum improvement
potential
c) Member is no longer eligible to receive services from
Neighborhood
d) Member has demonstrated non-adherence to the care plan and is
not engaged in the program
e) Care Manager outreach attempts fail to elicit a return response
or phone call from the member (three telephone contacts and 1
“Call Me” letter sent at minimum)
f) Member has transitioned to another Care Management Program
g) Member has expired
h) Member (or his / her guardian or family) no longer wishes to
participate
3) If the member is in the custody of DCYF, Neighborhood’s Case Managers are
responsible to contact the DCYF caseworker prior to the member’s discharge
from the Care Management Program.
4) Care Managers document the reason for case closure and close the case in the
case management software system. The member (or parent/guardian as
applicable) is transferred to Neighborhood’s Interactive Voice Response (IVR)
system, as appropriate, so that the member (parent/guardian) may complete an
automated satisfaction survey.
5) If a case is closed due to the inability to locate a member (parent/guardian) after
following the case closure criteria listed above, there is no transfer into the
Interactive Voice Response (IVR) system. The case is closed as “unable to
locate”.
J.. Referrals to Care Management Programs other than through Enrollment screens
Neighborhood’s Medical Management Department utilizes the following sources of
data to identify members who may benefit from complex case management
intervention in order to maximize positive health outcomes and to provide high
quality, member-focused, and cost effective care.
• Claims or encounter data
• Hospital discharge data
• Pharmacy data
• Data collected through utilization management processes
The Care Management Program has established multiple referral mechanisms for
members to be considered for case management services in a timely manner and in some
cases, in advance of the data sources described above. These include but are not limited
to:
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