Care Coordination/Care Management

Rhode Island’s health care system incorporates aspects of care coordination and care management as follows:

• Individual and group hospital or medical expense insurance policies must provide case management and develop service plans for covered dependent children.1
• Pharmacists and physicians may enter into “collaborative practice agreements” to manage patients drug therapy.2
• The department of behavioral healthcare, developmental disabilities and hospitals3 must administer “a comprehensive and coordinated program for the treatment of alcoholics and intoxicated persons” 4 that utilizes individualized treatment plans and coordinates care.5 The department must also administer a pilot program that provides substance abusers treatments and referral services as an alternative to emergency room service and that will facilitate “their entry into a continuum of care for treatment and recovery.”6
• HIV CTRS sites provide HIV counseling, testing, and referral services.7
• The director of health must administer a Rhode Island chronic care management program8 while the department of health’s plan for improving care provided by “the statewide system for stroke response and treatment” must incentivize and facilitate the sharing of health information by health professionals.9
• The department of human services must administer a system for long-term care that supports consumer choice and provides coordinated services10 as well as a “long-term care entry system” that provides long-term care assessments, care management services, and recommendations to individuals seeking long-term care.11 Skilled nursing facilities and intermediate care facilities must conduct patient assessments to determine patients’ needs for various services including case management and home health care.12
• The department of elderly affairs must administer a “long-term care assessment and care management program” to provide “chronically impaired or disabled persons” with an assessment of their need their long-term care and supports and information on their long-term care options.13
• Rhode Island’s Medicaid program delivers care through a managed care system and utilizes the “medical home” model to assure appropriate care and deter unnecessary services.14Medicaid recipients that are eligible for long-term care assistance may receive institutional services, home and community based services, medication management, and transition services.15 The Assessment and Coordination Unit (ACU) will assess an individual’s long-term care needs16 establish a plan of care.17