Population Risk Level Requirements
Percentage of FHP members of our total membership that must be in high acuity.
What is 2%
Care Naviagator Caseload Maximum.
What is 600:1
3 HRS's per day
What is Care Navigator assessment productivity goal.
10% Reduction in Behavioral Health Spend
What is our ICM Behavioral Health Department Goal
Idividualized Plan of Care (IPOC) are required for these members.
What is Moderate and High acuity members
Percentage of our ACA population of our total membership that must be in high acuity.
What is 2%
Care Manager caseload maximum.
What is 75:1
Must have outreach every 90 days
What is the outreach requirement for Moderate acuity members.
Goal Percentage of accurate audited files 4th quarter and beyond.
What is 90%
Type of Note used for the Initial Care Plan creation with member or member guardian
What is care plan note
Percentage of ICP (Seniors or Persons with Disabilities) members in our total membership that must be in high acuity.
What is 5%
Program Specialist caseload maximum.
What is 150:1
1 HRA a day
What is daily productivity goal for Care Managers and BH Specialist
Meeting required annually for all High risk members.
What is an Interdisciplinary Care Team Meeting (ICT)
Type of note used when you are contacting member to determine progress on the IPOC.
What is Care Plan Update note
Percentage of Special-Needs Children in our membership that must be high acuity.
What is 100%
Behavioral Health Specialist Caseload maximum.
What is 75:1 but if mixed caseload up to 90 active cases
2 HRA's a day
What is the daily productivity goal for a Program Specialist
Is required to be completed within 60 days of member enrollment into NLH plan.
What is a Health Risk Screening
Problem, Goal, Interventions, and Barriers
What is required components of the IPOC
296 ACA
102 FHP
321 ICP
What is current number of members in High acuity
Need
1,156 both ACA and FHP
2,891 ICP
Membership total 57,817
Program Specialist has 160 case 130 Active and 30 Pending. Is the Program Specialist over their caseload maximum?
What is No, the Program Specialist has 130 active cases under the 150:1 caseload maximum.
Outreach to member is required every 30 days
What is outreach requirment for High acuity members.
Is required within 90 days of enrollment in NLH for any moderate or high members.
Health Risk Assessment
Required specialized plan for members with Behavioral Health conditions
What is Crisis Safety Plan