Glossary of Terms

Care Coordination
Deliberate organization of member care activities by a person or entity (e.g., Health Homes) formally designated as primarily responsible for coordinating services furnished by providers involved in a member's care. This coordination may include care provided by network or non-network providers. Organizing care involves the marshaling of personnel and other resources needed to carry out all required member care activities; it is often facilitated by the exchange of information among participants responsible for different aspects of the member's care.
Care Management
Overall system of benefit package service/management administered by the Plan and which encompasses utilization management, care coordination, facilitating continuity of care during care transitions (i.e., changes in levels of care, aging out of the Children's System of Care or member relocation), management of the quality of care, chronic condition management, and independent peer review.
Case Management
A process managed care plans may use to review the care that patients receive. The goal of case management is to ensure that patients receive the appropriate service from the right provider, at the right time, and in the least costly setting. Case management is typically performed by physicians or nurses who are paid by the plan.
Center for Integrated Health Solutions (CIHS)
A part of SAMHSA, this center promotes the development of integrated primary and behavioral health services to better serve individuals with mental health and substance use conditions.
Clinical Practice Guidelines
Systematically developed statements regarding assessment and intervention practices. These guidelines were created to assist with practitioner and patient/consumer decisions about appropriate health care for specific circumstances. The goals of clinical practice guidelines are to describe appropriate care based on the best available scientific evidence and broad consensus; reduce inappropriate variation in practice; provide a more rational basis for referral; provide a focus for continuing education; promote efficient use of resources; and act as a focus for quality control.
Collaborative Care
The collaborative care model is an evidence-based approach for integrating physical and behavioral health services that can be implemented within a primary care-based setting. It is a multicomponent, system-level intervention that includes care coordination and care management; regular and proactive monitoring using validated clinical rating scales; and routine, systematic caseload reviews and monitoring by psychiatrists who are also available to consult with individuals who do not show improvement. Many randomized controlled trials have shown collaborative care for common mental disorders such as depression to be more effective and cost-efficient than usual care. Collaborative care has been shown to improve symptoms, treatment adherence, quality of life/functional status, and satisfaction with care for individuals with depression.
Community Inclusion
The full participation by an individual living with mental illness and/or substance use disorders in living arrangements, activities, organizations and groups of his/her choosing in the community.
Community Support Specialist (CSS)
Responsible for arranging/providing services to consumers that encourage and promote healthy functioning, recovery efforts, consumer independence/self-care and responsibility.
A member who is receiving or has received mental health/substance use disorder services under the Contract.
Consumer Assessment of Healthcare Providers and Systems (CAHPS)
A survey that asks consumers to report on and evaluate their experiences with health care.
Credentialed Alcoholism and Substance Abuse Counselor (CASAC)
Individuals who provide alcoholism and substance abuse counseling services in approved work settings as defined by NYS OASAS.
Cultural Competence
Having the capacity to function effectively within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.