Friday, November 20, 2015

#Waiverwise: Case Management

Waiver services should be person centered. You will create a Service Plan within the budget limit ( $16,545 annually for FSW). There is more information available on this process in the waiver manual.

More information, including service costs, available in the manual:
http://provider.indianamedicaid.com/ihcp/manuals/DDRS%20HCBS%20Waiver%20Provider%20Manual.pdf

Case Management


Case Management services means services that enable a participant to receive a full range of appropriate services in a planned, coordinated, efficient, and effective manner. Case Management assists participants in gaining access to needed waiver and other Medicaid State Plan services, as well as needed medical, social, educational and other services, regardless of the funding source for the services to which access is gained. Case Management services must be reflected in the Individual Support Plan (ISP) and must address needs identified in the person-centered planning process.

Reimbursable activities under Case Management services include the following: 
 Developing, updating, and reviewing the ISP using the person-centered planning process.  Convening team meetings at least every 90 days and as needed to discuss the ISP and any other issues needing consideration in relation to the participant. 
 Completion of a DDRS-approved risk assessment tool during service plan development, initially, annually, and when there is a change in the participant’s status. 
 Monitoring of service delivery and utilization (via telephone calls, home visits, and team meetings) to ensure that services are being delivered in accordance with the ISP. 
 Completing and processing the annual level of care determination. 
 Compiling case notes for each encounter with the participant. 
 Conducting face-to-face contacts with the individual (and family members, as appropriate) at least once every 90 days in the home of the waiver participant and as needed to ensure health and welfare and to address any reported problems or concerns. 
 Completing and processing the 90-Day Checklist. 
 Developing initial, annual, and update Cost Comparison Budgets using the State-approved process. 
 Disseminating information including all Notices of Action and forms to the participant and the IST.
  Completing, submitting, and following up on incident reports in a timely fashion using the State-approved process, including notifying the family/guardian of the incident outcome, all of which must be verifiable by documented supervisory oversight and monitoring of the Case Management agency. 
 Monitoring participants’ health and welfare.  Monitoring participants’ satisfaction and service outcomes.  Monitoring claims reimbursed through the approved Medicaid Management Information System (MMIS) and pertaining to waiver-funded services. 
 Maintaining files in accordance with State standards. 
 Cultivating and strengthening informal and natural supports for each participant. 
 Identifying resources and negotiating the best solutions to meet identified needs

 Case Managers must understand, maintain, and assert that the Medicaid program functions as the payer of last resort. The role of the Case Manager includes care planning, service monitoring, working to cultivate and strengthen informal and natural supports for each participant, and identifying resources and negotiating the best solutions to meet identified needs. 
Toward these ends, Case Managers are required to  Demonstrate a willingness and commitment to explore, pursue, access, and maximize the full array of non-waiverfunded services, supports, resources and unique opportunities available within the participant’s local community, thereby enabling the Medicaid program to complement other programs or resources.  Be a trained facilitator who has completed a training provided by a DDRS/BDDS-approved training entity or person; observed a facilitation; and participated in a person-centered planning meeting prior to leading an IST.  Participate in developing, updating, and reviewing the ISP using the person-centered planning process that is used as the basis for care planning.  Monitor participant outcomes using a State-approved standardized tool.  Convene team meetings at least quarterly and as needed.  Complete and process the annual level of care determination within specified time frames.  Maintain case notes for each participant on no less than a monthly basis.  Complete the DDRS-approved risk assessment tool during initial assessment, annually, and any time there is a change in the participant’s status.  Monitor service delivery and utilization (via telephone calls, home visits, and team meetings) to ensure that services are being delivered in accordance with the ISP.  Conduct face-to-face contacts with the individual (and family members, as appropriate) at least once every 90 days in the home of the participant and as needed to ensure health and welfare and to address any reported problems or concerns.  Complete and process the 90-Day Checklist in a timely fashion. (Completion must be face-to-face.)  Develop the annual Cost Comparison Budgets using the State-approved process.  Develop updated Cost Comparison Budgets, as needed, using the State-approved process.  Disseminate information, including all Notices of Action and forms, to the participant and the IST within specified time frames.  Complete, submit, and follow up on incident reports in a timely fashion using the State-approved process, including notifying the family/guardian of the incident outcome, all of which must be verifiable by documented supervisory oversight and monitoring of the Case Management agency.  Monitor participants’ health and welfare.  Monitor participants’ satisfaction and service outcomes.  Monitor claims submitted through the approved Medicaid Management Information System (MMIS) and pertaining to waiver-funded services.

Case Management services are required under both the Family Supports Waiver and the Community Integration and Habilitation Waiver. 

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