Current through Vol. 42, No. 1, September 16, 2024
(a)
Case
management agencies. Services are provided by case management agencies
established for the purpose of providing case management services. Medicaid
Child Welfare Targeted Case Management (CWTCM) services must be made available
to all eligible recipients and must be delivered by provider agencies on a
statewide basis with procedures that assure 24 hour availability, the
protection and safety of recipients, continuity of services without
duplication, and compliance with federal and State mandates and regulations
related to servicing the targeted population are met in a uniform and
consistent manner. The agency must demonstrate that their staff has:
(1) a minimum of five years experience in
providing all core elements of case management services including:
(A) individualized strengths and needs
assessment;
(B) needs-based service
planning;
(C) service coordination
and monitoring; and
(D) on-going
assessment and treatment plan revision.
(2) a minimum of five years experience in
providing case management services that coordinate and link the community
resources required by the target population.
(3) a minimum of five years experience in
meeting the case management and service needs of the target
population.
(4) an administrative
capacity to insure quality of services in accordance with State and federal
requirements.
(5) a financial
management capacity and system that provides documentation of services and
costs.
(6) a capacity to document
and maintain individual case records in accordance with State and federal
requirements.
(7) ability to meet
all State and federal laws governing the participation of providers in the
State Medicaid program including, but not limited to, the ability to meet
federal and State requirements for documentation, billing and audits.
(b)
Provider
agreement. A Provider Agreement between the Oklahoma Health Care
Authority and the provider for CWTCM services must be in effect before
reimbursement can be made for compensable services.
(c)
Qualifications of individual case
managers. A targeted case manager for the CWTCM program must:
(1) be employed by the provider
agency.
(2) possess at minimum, a
bachelor of social work degree; or a bachelor's degree and one year of
experience in professional social work; or a master's degree in behavioral
science.
(3) possess knowledge of
the principles and practices of:
(A) social
work;
(B) laws, rules, regulations,
and policies and procedures governing agency programs;
(C) community resources;
(D) human developmental stages and related
dysfunctions;
(E) sensitivity to
cultural diversity;
(F) emotional,
physical and mental needs of clients; and
(G) counseling programs and
services.
(4) possess
skill in:
(A) interviewing;
(B) getting clients to explore opportunities
and extracting information;
(C)
casework management;
(D) setting
goals in cooperation with clients;
(E) time management;
(F) prioritizing and organizing needs of
clients;
(G) courtroom testimony,
terminology and procedures;
(H)
crisis intervention;
(I) working
with a multidisciplinary approach; and
(J) developing, evaluating and modifying an
intervention plan on an ongoing basis.
(d)
Provider selection.
Provision of case management services must not restrict an individual's free
choice of providers. Eligible recipients must have free choice of providers of
case management as well as providers of other medical care under the
plan.
Added at 14 Ok Reg
3711, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff
5-11-98
