Current through Register Vol. 18, September 20, 2024
(1) The PCRP is developed by the enrolled
member and the case management team to meet the enrolled member's identified
needs as well as cost of identified services.
(2) All services must be specifically
authorized in writing in the enrolled member's PCRP.
(3) Each PCRP must be developed, reviewed,
and revised by the CIO case management team. The case management team must:
(a) develop an initial PCRP upon the enrolled
member's enrollment into the SDMI HCBS waiver program which is the date the
enrolled member begins receiving services under the SDMI HCBS waiver
program;
(b) ensure the initial
PCRP includes all aspects of (5)(a) through (m) based on the LOC, LOI, and the
information obtained by the case management team;
(c) initiate the strength assessment upon the
enrolled member's enrollment into the SDMI HCBS waiver program to determine the
enrolled member's strengths, needs, preferences, goals, and desired outcomes,
along with his/her health status and risk factors;
(d) complete the strength assessment within
three months of the enrolled member's enrollment into the program. Upon
completion of the strength assessment, the PCRP is finalized;
(e) have monthly telephone contact with the
enrolled member consisting of monthly monitoring calls;
(f) conduct in-person reviews of the PCRP
with the enrolled member every three months. Any issues with the PCRP and the
delivery and implementation of services are to be discussed at this time. The
review is conducted at the enrolled member's place of residence, place of
service, or other appropriate setting, as determined by the enrolled member's
needs. This is an opportunity for case management teams to monitor the health
and welfare of the enrolled member and evaluate the delivery of services to the
enrolled member. This review includes evaluating and assessing strategies for
meeting the needs, preferences, and goals of the enrolled member. It also
includes evaluating and obtaining information concerning the enrolled member's
satisfaction with the services, the effectiveness of services being provided,
changes in the enrolled member's function, and cost effectiveness of the
services.
(g) update the PCRP to
reflect any changes to the information listed in (5)(a) through (j);
and
(h) complete an annual review
of the PCRP with the enrolled member and update the PCRP if there are any
changes to the information listed in (5)(a) through (j).
(4) The case management team must develop the
PCRP in consultation with:
(a) the enrolled
member or the enrolled member's legal representative;
(b) the enrolled member's treating
professional and other appropriate health care professionals; and
(c) others who have knowledge of the enrolled
member's needs.
(5) The
PCRP must include:
(a) the primary SDMI
diagnosis and any other diagnosis of the enrolled member that are relevant to
the services provided;
(b) the
enrolled member's symptoms, complaints, and complications indicating the need
for services;
(c) the enrolled
member's strengths, areas of concern, goals, objectives, and required
interventions;
(d) the SDMI HCBS
waiver program services that will be provided;
(e) all other services the enrolled member
requires including Montana Medicaid state plan services and community-based
services and supports. However, including non-program services in the PCRP does
not obligate the department to pay for the non-program services or ensure their
delivery or quality;
(f) a
description of how each service addresses each of the enrolled member's
functional needs outlined in the Severe and Disabling Mental Illness, Home and
Community Based Services, Evaluation and Level of Impairment form;
(g) a crisis plan;
(h) physicians' orders;
(i) a discharge plan;
(j) the projected annual cost of SDMI Home
and Community-Based Services (HCBS) waiver program services provided;
(k) the signature of the enrolled member or
the enrolled member's legal representative which signifies the participation in
and agreement of the PCRP;
(l) the
names and signatures of all individuals who participated in the development of
the PCRP which signifies the participation in and agreement of the PCRP;
and
(m) the enrolled member's bill
of rights that informs enrolled members they have the right to choose from the
full range of services available in the waiver if appropriate and that services
will be delivered by a qualified provider of the enrolled member's
choice.
(6) The case
management team must provide a copy of the plan to the recipient.
(7) The case management team must retain all
of the enrolled member's records in accordance with ARM
37.85.414.
(8) The PCRP must be approved by the
department initially and then annually. The annual review must ensure
compliance with this rule and federal guidance. If the initial PCRP is found to
meet program criteria, the department must approve the PCRP within 30 days of
enrollment into the care management system.
(9) The department reviews all initial and
annual PCRP and at any time there is a change.
(10) The PCRP is subject to review by the
department at any time.
AUTH:
53-2-201,
53-6-402, MCA; IMP:
53-6-402,
MCA
