Current through Register Vol. 43, No. 02, November 27, 2024
(1) Providers of
case management services must meet the following requirements:
(a) CMSP for the mentally ill must be
certified by the Department of Mental Health as meeting the qualifications for
enrollment as a case management provider under the provision of
560-X-40-.01(6);
(b) CMSP for intellectually disabled adults
must meet the qualifications for enrollment as a case management provider under
the provision of
560-X-40-.01(7);
(c) CMSP for disabled children, foster
children, pregnant women, and AIDS/HIV-positive individuals, adult protective
service individuals, individuals who meet the eligibility criteria for the HCBS
Technology Assisted Waiver (TAW), for Adults and individuals who meet the
eligibility criteria for Substance Use Disorders, and for disabled children who
meet the requirements for Autism Spectrum Disorder (ASD), disabled children who
meet the requirements for Seriously Emotionally Disturbed (SED), and for adults
who meet the requirements for Severe Mentally Illness (SMI) - High Intensity
Care Coordination must meet the following criteria:
1. Demonstrated capacity to provide all core
elements of case management:
(ii) Care/services plan
development,
(iii)
Linking/coordination of services, and
(iv) Reassessment/follow-up.
2. Demonstrated case management
experience in coordinating and linking such community resources as required by
the target population.
3.
Demonstrated experience with the target population.
4. Administrative capacity to ensure quality
of services in accordance with state and federal requirements.
5. A financial management system that
provides documentation of services and costs.
6. Capacity to document and maintain
individual case records in accordance with state and federal
requirements.
7. Demonstrated
ability to assure a referral process consistent with Section 1902a(23), freedom
of choice of provider.
8.
Demonstrated capacity to meet the case management service needs of the target
population.
(d) Shall be
in full compliance with Title VI of the Civil Rights Act of 1964 and Section
504 of the Rehabilitation Act of 1973;
(e) Shall be in full compliance with
applicable federal and state laws and regulations.
(2) Eligibility is limited to:
(a) Medicaid-eligible individuals age 18 and
over who have a diagnosis of mental illness as established in Rule
560-X-40-.01.
(b) Medicaid-eligible individuals age 18 and
over who have a diagnosis of intellectually disabilities as established in Rule
560-X-40-.01.
(c) Medicaid-eligible individuals age 0-21
who are considered to be disabled as established in Rule
560-X-40-.01.
(d) Medicaid-eligible individuals age 0-21
who are in the care, custody, or control of the State of Alabama as established
in Rule 560-X-40-.01.
(e) Medicaid-eligible women of any age in
need of maternity services as established in Rule
560-X-40-.01.
(f) Medicaid-eligible individuals of any age
who have been diagnosed as having AIDS or being HIV-positive as established in
Rule 560-X-40-.01.
(g) Medicaid-eligible individuals age 18 and
over who are at risk of abuse, neglect, or exploitation as established in Rule
560-X-40-.01.
(h) Medicaid-eligible persons who meet the
eligibility criteria for the HCBS Technology Assisted Waiver for (TAW) Adults
as outlined in the scope of service definition in the approved waiver document
as established in Rule
560-X-40-.01.
(i) Medicaid-eligible persons who meet the
eligibility criteria for Substance Use Disorders as established in Rule
560-X-40-.01.
(j) Medicaid-eligible persons who meet the
eligibility criteria for Disabled Children with Autism Spectrum Disorders,
Disabled Children with Serious Emotional Disturbances, and Adults with Severe
Mentally Illness - High Intensity Care Coordination as established in Rule
560-X-40-.01.
(3) Targeted Case Management
cannot provide services in total care environments, such as nursing facilities,
hospitals, and residential programs unless the recipients are in Adult
Protective Services Target Group 7, or this target group includes individuals
transitioning to a community setting. Case-management services will be
available for up to 180 consecutive days of a covered stay in a medical
institution. The target group does not include individuals between ages 22 and
64 who are served in Institutions for Mental Disease or individuals who are
inmates of public institutions. (State Medicaid Directors Letter (SMDL), July
25, 2000). Also excluded are individuals receiving services in an Institution
for Mental Disease (IMD).
(4) A
Medicaid recipient may receive Targeted Case Management services in more than
one target group or case management services from another program if the Agency
determines this would not present a duplication of services.
(5) Targeted case management services for all
target groups will be available in all areas of the state.
Author: Latonda Cunningham, Administrator,
Managed Care Division
Statutory Authority: 42 C.F.R, § 435;
§ 1915(g), Social Security Act, Title XIX; State Plan for Medical
Assistance, Attachment 3.1-A, Supplement 1; OMB No. 0939-0193.
