Managed Medical Assistance Story #1

A child enrolled in Simply Healthcare plan was referred to a Case Manager following a hospital discharge.  The member has a history of running away, substance abuse, and major depressive disorder. The member had been receiving outpatient behavioral services from a mental health hospital in addition to a therapist, targeted case manager, and psychiatrist. She was hospitalized several times prompting the targeted case manager and health plan case manager to suggest Statewide Inpatient Psychiatric Program (SIPP) residential services, where she would receive more intense services on a daily basis. The Case Manager participated in a monthly treatment meeting with the SIPP facility in order to monitor and assure she was receiving the proper assistance. The member has successfully been integrated back to her home and daily routines. Her mother has continuously reported a significant difference in behavior at home, school, and positive responses during therapy. She is no longer running away, is making positive choices and changes. The Case Manager continues to assist the mother with support, guidance, and care in order to assure the member remains on a positive path.