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Targeted Case Management Services (CM)

OPTUM IDAHO LEVEL OF CARE GUIDELINES: CASE MANAGEMENT – OPTUM IDAHO MEDICAID

BH803IDCM_012017 Page 2 of 3 Level of Care Guidelines: Case Management – Optum Idaho Effective July 2017 Proprietary Information of Optum. Copyright 2017 Optum, Inc.

Case management services do not include the direct delivery of services, and cannot be provided by a behavioral health network provider when the member is already receiving the service from another Medicaid provider.

Case Management: Case Management is provided by a network provider who facilitates access to needed services for individuals through comprehensive assessment, service planning, referral, and monitoring of the member’s service needs/activities. The members are those who have serious mental illness, or children with serious emotional disturbance, or a behavioral health diagnosis.

Case Management services are provided to members who are unable to navigate the service system on their own, and do not have the assistance of other natural supports or resources to help them access needed services.

Case management services are intended to help the member who is seeking services, to learn about or gain access to behavioral health, medical and social services and providers, until the member is capable of accessing these services independently.

Case Management services vary in intensity, frequency, and duration in order to support the member’s ability to access and utilize social services, behavioral health services or medical services, and social resources that support the member to reach their treatment plan goals.

Case management can be delivered as a community-based service or in the outpatient clinic setting.