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Case Management

Case management assists participating providers in the care of members with special needs or complex mental health problems. Case management is available plan-wide.

The following types of cases are most commonly referred to mental health case management:

  • Pregnant and substance-abusing members with treatment compliance and relapse problems.
  • Two or more readmissions within three months.
  • Chronic lethality risk with history of suicide attempts.
  • Chaotic family contributing to high use of service/cost of service.
  • Dual-diagnosed (substance abuse and mental health) members with more than two admissions in a three-month period and treatment compliance problems.
  • Children and adolescents at risk of out-of-home placement or loss of parental custody as indicated by either prior, current, or record of considerations of out of home placement or removal of parental custody.



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Last Updated On: 12/4/2020