Connecticut Administrative Code
Title 17a - Social and Human Services and Resources
301 - Promotion of Independent Living for the Elderly Program
Section 17a-301-4 - The coordination, assessment and monitoring process
Universal Citation: CT Reg of State Agencies 17a-301-4
Current through March 14, 2024
(a) Screening. Referrals shall be reviewed within 5 work days after they are received, using a form approved by the Commissioner on Aging.
(1) The CAM
agency shall either schedule an assessment, place the applicant on a waiting
list if available funding or workload do not permit immediate assessment, or
reject the applicant as inappropriate for the program.
(2) In the event that an assessment is not
scheduled, the individual shall be notified of the disposition of the
application (waiting list or rejection) and the reasons for the action taken
within 72 hours of screening by the CAM agency. The individual shall be
referred to other agencies for assistance if appropriate.
(b) Assessment.
(1) An assessment is scheduled and shall be
performed within seven days, if there is available funding and staff or when an
individual's name has been reached on the waiting list.
(2) The assessment will be performed using
the instrument specified by the Department to assess the functional,
psychological, cognitive, social, environmental, financial and health status of
the individual, and the extent to which informal supporters are available or
active in the individual's care. The assessment shall be performed by a case
manager.
(3) The CAM agency shall
use its best efforts to obtain relevant information from any other health or
social service agencies or professionals which have provided services or care
to the individual. The CAM agency shall first obtain signed releases from the
individual or responsible party.
(4) Upon completion of the assessment, the
CAM agency shall discuss with the individual, or responsible party, the
findings of the agency and send a written notice to the individual or
responsible party making a referral. The notice shall state:
(A) Whether the individual is eligible for
admission to the Program; or
(B)
The reason for a determination of ineligibility if applicable;
(C) In the event of a determination of
ineligibility, notice of appeal rights, including the procedure to be used and
any deadlines and the name and telephone number of a person to contact for more
information on the appeals process.
(c) Individualized Plan of Care.
(1) Upon admission into the Program, an
individualized plan of care shall be developed for each client by the case
manager assigned to the client. The plan of care shall include all services the
client needs to safely remain in the community. The plan of care includes
services to be provided by informal supporters and any services to be funded by
third party payers.
(2) The case
manager shall involve the client and any key informal supporters identified
during the assessment in developing the plan of care. The client, or other
responsible party, must indicate approval of the plan of care prior to
implementation.
(3) The case
manager shall determine which services will meet the needs of the client. When
more than one type of service will equally meet the identified needs, the case
manager shall choose the type with the lower cost. When more than one person or
agency provides a necessary service of equal quality, the case manager shall
choose the one offering the lower cost.
(4) The case manager shall obtain funding for
necessary services from all third party funding sources available. Program
funds will be used only when no other funding source is available. In no event
shall the cost to the Department exceed 60 percent of the annualized weighed
average daily rate for skilled and intermediate nursing care in Connecticut in
effect on January 1st, as determined by the Commissioner of Income
Maintenance.
(5) In the event that
a person other than a legally liable relative agrees to assume responsibility
for the client's share of the costs, amounts paid by such person shall not be
counted as income to the client for the purposes of determining eligibility or
required contributions.
(d) Individualized Plan of Care Implementation.
(1) Services other
than assessment and case management will be obtained from community service
providers.
(2) Services paid for
with Program funds will be procured through subcontracts and individual service
orders.
(3) The CAM agency shall
not use Department funds to purchase community services from itself or any
related parties.
(4) Services paid
for through other funding sources will be arranged by the case manager, who
will assist the client in completing applications and any necessary intake
processes.
(e) Monitoring and Case Management.
(1) Clients who require ongoing case
management shall be monitored by the case manager as follows:
(A) Reviewing the care plan at least every 60
days,
(B) Making a home visit to
the client at least every six months to determine the appropriateness of the
service plan and to assess changes in the client's condition. The case manager
shall conduct a formal reassessment of the client's health, functional and
financial status and service needs every twelve (12) months,
(C) monitoring service delivery, including
reviewing provider reports and records of service delivery, and
(D) responding to changes in client needs as
they occur, making appropriate changes in the type, frequency, cost or provider
of services needed for the client to remain in the community.
(E) In accordance with any additional
requirements established under the agency's licensure.
(2) Ongoing monitoring by a case manager may
be suspended for a client who, at the time of the sixty (60) day care plan
review, meets the following criteria:
(A) The
client's functional and cognitive status have been determined to be stable
(this can include the presence of chronic health problems if the conditions are
under control and do not require intervention by a case manager), and
(B) No changes in the total plan of care are
anticipated during the following sixty (60) days with the exception of changes
in the particular individuals who are providing care or scheduled terminations
of short-term services, and
(C) The
client or a legal representative has signed a consent form accepting the
suspension of monitoring services and indicating that either the client or a
responsible party will regularly monitor the client's needs and promptly report
changes therein to the case manager.
(3) When ongoing monitoring by a case manager
has been suspended, the client may continue to receive other home care services
through this program. The department shall require renewals of service orders
at least every six months and annual redeterminations of eligibility in order
to continue services. If the client's condition becomes unstable and the client
continues to reside in the community, the CAM agency shall reinstate monitoring
services within seven days.
(f) Discharge.
(1) A client must be discharged from the
Program under any of the following conditions:
(A) The client has been institutionalized in
an acute or long term care facility for a period exceeding 90 days;
or
(B) It has been determined that
a client who has been institutionalized in an acute or long term care facility
for less than 90 days will not be able to return to the community within that
period of time; or
(C) The client
is no longer eligible for the program (see Sec.
17a-301-3 a);
or
(D) The client's condition
improves to the point where he or she is no longer in need of case management
or other services funded by the department; or
(E) The client is admitted to the Nursing
Home Preadmission Screening and Community Based Services Program or is enrolled
in the Protective Services for the Elderly Program for 90 days or more;
or
(F) The client or family fails
to make mandatory co-payments; provided clients will not be discharged if:
(1) a provider agrees to absorb the client's
share of costs, or
(2) if a
charitable, religious or other non-state funding source agrees to make
co-payments on the client's behalf, or
(3) the client qualifies for an exception to
the co-payment requirement as determined under Section
17a-301-3 of these
regulations.
(G) The
client takes up residence in another state.
(H) The client voluntarily withdraws from the
program or refuses all services.
(2) The CAM agency will develop a discharge
plan which ensures the continued well being of the client to the maximum extent
possible.
(3) When a client is to
be discharged, the client or responsible party will be given at least ten (10)
days notice and will be notified of the reason for discharge and the client's
right to appeal. The reason for discharge will be entered into the client's
file with all relevant documentation.
(4) CAM agencies will have written discharge
policies and will notify the client or responsible party of these policies at
the time of admission.
(5) Nothing
in these regulations shall be deemed to require the CAM agency or any provider
to provide services if it has determined that continued participation would
constitute an unacceptable risk to the safety the client or others.
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