(a) Case management
is a mandatory service for all participants enrolled on the waivers.
(b) Case managers shall complete all
eligibility paperwork, as established under Chapter 46 of the Department of
Health's Medicaid Rules, within thirty (30) calendar days.
(c) The case manager shall use
person-centered planning to understand the needs, preferences, goals, and
desired accomplishments of the participant. The case manager shall coordinate
and assist the participant in accessing all needed and available resources,
such as natural, paid, and community support. The case manager shall develop
and monitor the implementation of an individualized plan of care.
(d) The case manager shall assure that all
information, including but not limited to guardianship paperwork and physical
and mailing addresses of the participant, legally authorized representative(s),
and other contacts is updated and accurate at all times. The case manager shall
update the Division and other providers of any changes.
(e) The case manager shall maintain a
participant's file and service documentation.
(i) The case manager shall assure information
is disseminated to, and received by, the participant and appropriate parties
involved in the participant's care or as authorized by a signed release of
information by the participant or the participant's legally authorized
representative(s).
(ii) The case
manager shall arrange and coordinate eligibility for applicants or waiver
participants by providing:
(A) Targeted case
management services to an applicant who is in the eligibility process for
waiver services or awaiting a funding opportunity; and
(B) Services that include the coordination
and gathering of information needed for initial and annual certification,
clinical and financial eligibility, and the level of care
determination.
(iii) The
case manager shall provide the participant and any legally authorized
representative(s) with a list of all providers available in their community in
order to allow the participant a choice of providers. To the extent that they
are available, participant choice shall include any certified waiver provider,
self-directed options, Medicaid State Plan services, and services offered by
other state agencies, as well as community and natural supports.
(A) At least once every six (6) months, the
case manager shall provide information to the participant or the legally
authorized representative(s) on all available waiver services, including
self-direction service delivery options. This may be done more frequently as
requested by the participant or legally authorized representative(s).
(B) The case manager shall coordinate
transition plans when the participant chooses to change, stop, or add providers
to his or her individualized plan of care, or exit the waiver, as established
under Section
22 of this Chapter.
(C) If the case manager chooses to
discontinue providing services, the case manager shall give the participant,
legally authorized representative(s), and Division thirty (30) calendar days
written notice. The case manager shall continue to provide case management
services for the thirty (30) calendar days, or until a new case manager is
approved, whichever is first.
(iv) The case manager shall involve and
assist the participant's plan of care team with developing a person-centered
individualized plan of care in accordance with this Chapter. The case manager
shall assist the team with planning, budgeting, and prioritizing services for
the participant using all available resources and the assigned individual
budget amount.
(v) The case manager
shall complete and submit the individualized plan of care, including all
required components, in EMWS, or its successor, at least thirty (30) days
before the intended plan start date.
(vi) If the participant chooses to
self-direct services on the waiver, the case manager shall assist the
participant in modifying the individualized plan of care as needed, and
monitoring the services of the Financial Management Service utilized by the
participant in accordance with the approved waiver.
(vii) The case manager shall ensure all
providers on the participant's individualized plan of care sign off on the
plan, receive a copy of the plan, receive team meeting notes, and complete
participant specific training as required in Section
15(g) of this Chapter.
Documentation of participant specific training shall be available to the
Division upon request.
(viii) The
case manager shall monitor and evaluate the implementation of the participant's
individualized plan of care, including a review of the type, scope, frequency,
duration, and effectiveness of services, as well as the participant's
satisfaction with the supports and services. On a quarterly basis, the case
manager shall include this information in a report prescribed by the
Division.
(ix) The case manager
shall report to the provider any concerns with provider implementation of the
individualized plan of care, or concerns with the health and safety of a
participant. Rule violations shall be reported to the Division through the
incident reporting or complaint processes.
(x) The case manager shall send the Division
and the provider or employer of record written notification of noncompliance
with these rules, the health, safety, or rights of the participant specified in
the individualized plan of care, or when documentation is not received by the
tenth (10th) business day of the following month after services were
provided.
(xi) The case manager
shall securely store and retain all confidential provider documentation
received from other providers for a participant's services for a twelve (12)
month period from the month services were rendered and shall follow safe
destruction policies as established under Section
7 of this Chapter, even if the participant
changes case managers.
(xii) The
case manager shall document all monitoring and evaluation activities, follow-up
on concerns and actions completed, and make appropriate changes to the
individualized plan of care with team involvement, as needed.
(f) The case manager shall be the
second-line monitor for participants receiving medications. Second-line
monitoring shall help to ensure a participant's medical needs are addressed and
medication regimens are delivered in a manner that promotes the health, safety,
and well-being of the participant. The case manager shall provide monitoring
of, and review trends regarding, the usage of the participant's
over-the-counter and prescription medications through a monthly review of
medication assistance records and PRN medication usage records.
(g) The Division may establish caseload
limits to ensure the case manager effectively coordinates services with all
participants on his or her caseload.
