Current through Register Vol. 56, No. 18, September 16, 2024
(a) Youth
Case Management (YCM) services are case management services provided to
Medicaid/NJ FamilyCare beneficiaries of CSOC services who are under the age of
18 or those young adults between the ages of 18 and 21 who are transitioning
from the child service system to the adult service system. YCM services ensure
that individualized mental, emotional, and/or behavioral health services are
obtained for the child, youth, or young adult by advocating for necessary
mental/behavioral services and other necessary financial, educational, social,
or other services to serve the needs of the child, youth, or young adult by
restoring, enhancing, and maintaining an optimal level of functioning,
ultimately reducing or eliminating the need for case management services.
1. YCM services that are included as part of
a transition/discharge plan from inpatient psychiatric hospitalization, CMO
services or other more intensive level of services, including, but not limited
to, discharge from a residential mental health rehabilitation program or
inpatient psychiatric hospitalization, are intended to support the maintenance
of the child, youth or young adult's attained treatment goals to facilitate a
successful transition from inpatient hospitalization or CMO services and
prevent a relapse which would result in rehospitalization or the need for
additional intensive services or return to previous out-of-home
placement.
(b) YCM
services shall include, but shall not be limited to:
1. Coordinating transition into YCM services
in collaboration with the CSA, the family and the community providers, and
facilitating transition out of YCM services to an alternate level of care and
case management as appropriate, ensuring linkages are in place prior to the
transition out of YCM services;
2.
Assessment, which is the ongoing process of identifying, reviewing and updating
a child, youth or young adult's strengths and needs, based upon input from the
child, youth or young adult, the caregiver(s), significant others including
family members, and behavioral health/mental health professionals. The
assessment process continues throughout the entire time the child, youth or
young adult receives YCM services;
3. Service planning, which is the process of
organizing the outcomes of the assessment in collaboration with the child,
youth or young adult, the caregivers, significant others, potential service
providers, and others as designated, coordinating the receipt of the concurrent
review information from provider(s) and formulating a written service plan that
addresses the child, youth or young adult's needs, planned services to address
these needs, and plans to remain in the community. The service planning process
continues throughout the child, youth or young adult's length of stay in YCM
services;
4. Services linkage,
which is the ongoing referral to, and enrollment and participation in, mental
health and/or non-mental health program(s). Mental health program linkage means
that the child, youth or young adult has completed the mental health program's
intake process, that the child, youth or young adult has been accepted for
service, and that the child, youth or young adult has effectively participated
in the program. Services linkage includes ensuring that individualized services
are obtained for the child, youth or young adult by facilitating linkages to
community based resources and/or services included in the plan of care and
preparing referral material for possible placement of the child, youth or young
adult into an out-of-home treatment setting;
5. Ongoing monitoring, which consists of both
beneficiary monitoring and service provider monitoring by the case manager, as
follows:
i. Beneficiary monitoring, which is
the ongoing review of the child, youth or young adult's status and needs, the
frequency of which is contingent upon the child, youth or young adult's risk
status and reported changes from the child/youth/young adult, significant
others and/or service providers. An update of the service plan may result from
the monitoring process to address changing needs. Beneficiary monitoring
includes reviewing progress made toward the attainment of the defined treatment
goals included in the individual YCM service plan, and ensuring that the child,
youth or young adult and his or her family or caregiver is afforded the
opportunity to participate in the beneficiary monitoring and review process;
and
ii. Service provider
monitoring, which is the process of routine follow-up with the child, youth or
young adult's service providers to assess if services are provided as planned
and if they meet the child, youth or young adult's needs. Provider monitoring
may result in the adjustment of the service plan including provider changes.
Service provider monitoring includes the following:
(1) Monitoring the plans, including the
medication management plan for beneficiaries in need of such plans;
and
(2) Coordination of services
from multiple providers including calling and coordinating treatment team
meetings of a child, youth or young adult's service providers until the child,
youth or young adult leaves the YCM program;
6. Ongoing support services, which is the
provision of face-to-face individualized support services for a child, youth or
young adult and their natural support system, including their family. The
frequency of support services is contingent upon the child, youth or young
adult's individual needs; and
7.
Advocacy, which is the process of assisting the child, youth or young adult in
accessing, receiving and maintaining receipt of all benefits to which he or she
is entitled. Beneficiary advocacy is an ongoing activity of the case manager,
and includes advocating for services to meet the needs, desires and rights of
the child, youth or young adult and his or her family or caregiver.
(c) YCM services include
eligibility processing activities. All YCM providers shall:
1. Complete a presumptive eligibility (PE)
application for each child, youth and young adult who is not otherwise covered
under Medicaid/NJ FamilyCare at the time of the referral to the YCM, if the PE
process has not already been initiated by another entity;
2. Submit all PE applications to
DMAHS;
3. Assure that YCM case
management and other appropriate staff complete DMAHS PE training;
4. Assist the child, youth or young adult
and/or his or her family in collecting the documentation required to complete
and submit a Medicaid/NJ FamilyCare application within 30 days of enrollment,
if this process has not already been initiated by another entity;
5. As family circumstances indicate, review
eligibility factors for each beneficiary and assist the beneficiary and/or his
or her family in applying for any and all benefits for which they may be
eligible, including, but not limited to, Medicaid/NJ FamilyCare; and
6. Assist the beneficiary and/or his or her
family in maintaining eligibility for Medicaid/NJ FamilyCare and other
benefits.