Taraet Group
Targeted
casemanagement
services will beprovided
to alcohol orotherdrug dependent
Medicaid clients who need assistance inobtaining
necessary social educationalvocational and other services
Areas ofstate in which services will be provided
x Entire State
Only
in thefollowing geographic
areasauthority
of section 1915 g 1 of the Act is invoked toprovide
services less than StatewideComparabilitv of services
2L Services are
provided
in accordance with section 1902 a 10 8 of the Act Services arenotcomparable
in amountduration and scopeDefinition of services
Case managementservices areservices furnished to assist individuals
eligible
under the State Plan ingaining
accessto needed medical social educational and otherservices Case
Management
includes thefollowing
assistanceComprehensive
assessment andperiodic
reassessmentof individual needstodetermine the need for any medical educational socialor other services These assessment activities includetaking
clienthistory
identifying
the individuals needs andcompleting
related documentation andgathering
information from other sources suchasfamily
members medicalproviders social workers and educators if necessary toform a
complete
assessment of the individual
TN No 08 008
Supersedes
TN No 06 002iJUL l 1 2Ul
Development
andperiodic
revision ofaspecific
careplan
that is basedonthe information collectedthrough
theassessmentspecifies
thegoals
and actionsto address the medical social educational and other services neededby
the individualincludes activities such as
ensuring
the activeparticipation
of theeligible
individual andworking
with the individual orthe individual s authorized health care decision maker and others todevelop
thosegoals
andidentifies a course of actionto
respond
to the assessed needs of theeligible
individualReferral and related activities
to
help
aneligible
individual obtain needed servicesincluding
activities thathelp
link anindividual witho medical social educational
providers
oro other programs and services that are
capable
ofproviding
needed services suchasmaking
referrals toproviders
for needed services andscheduling appointments
for the individualMonitoring
and follow up activitiesactivities and contacts thatarenecessary toensurethe care
plan
isimplemented
andadequately
addresses the individuals needs and which may be with the individualfamily
membersproviders
or other entitiesorindividuals and conducted asfrequently
as necessary andincluding
atleastone annualmonitoring
todetermine whether thefollowing
conditions are meto services are
being
furnished in accordance with the individuals careplan
o services in the careplan
areadequate
ando there are
changes
in the needsorstatusof the individual and ifsomaking
necessaryadjustments
in the careplan
and servicearrangements withproviders
TN No 08 008
Supersedes
TN No 06 002Approval
Date FEe z 0 2009 Effective DateCase
management
may include contacts with noneligible
individuals thataredirectly
related toidentifying
the needs and supports forhelping
theeligible
individualto access servicesQualifications of providers
Approved
services must beprovided
and recommendedby
apractitioner
that offers a substance abusespecialty
Services will be offered in facilities that have been licensedby
the Alcohol andDrug
Abuse Division ADAD of theDepartment
of Human Services orby physicians
orother identified licensedpractitioners
of thehealing
arts licensed and certifiedby Department
ofRegulatory Agencies
DORA ornationally
licensed and certifiedby
the National Association of Alcohol andDrug
Abuse Counselors NAADAC the AmericanSociety
of Addiction Medicine ASAM orthe American Board ofPsychiatry
andNeurology
ABPN Freedom of choiceThe Stateassuresthat the
provision
ofcasemanagement
services will not restrict an individualsfree choice ofproviders
in violation of section 1902 a 23 of the Act1
Eligible recipients
will have free choice of theproviders
ofcasemanagement
services within thespecified geographic
area identified in thisplan
2
Eligible recipients
willhave free choice of theproviders
of other medical care under theplan
AccesstoServices
The Stateassures thatcasemanagement services will notbe used to restrict an
individuals accesstoother services under the
plan
The Stateassuresthat individuals will not be
compelled
to receivecase management services conditionreceipt
ofcasemanagement services onthereceipt
of otherTN No 08 008
Supersedes
TNNo 06 002Medicaid services orcondition
receipt
of other Medicaid servicesonreceipt
ofcasemanagementservices
The State assuresthat individuals will receive
comprehensive
casemanagement
services on a one to one basisthrough
one case managerThe Stateassures that
providers
ofcasemanagement
services do not exercise the agencysauthority
toauthorizeordeny
theprovision
of other services under theplan
The Stateassures thatcase
management
isonly provided by
and reimbursed tocommunity
casemanagement providers
The Stateassuresthat Federal Financial
Participation
isonly
available tocommunity
providers
and will notbe claimedon behalf ofan individual untildischarge
from the medical institution and enrollment incommunity
servicesCase Records
Providers maintain case records that document for all individuals
receiving
casemanagementthe
following
the name of the individual dates of the casemanagement
services the name of theprovider
agency if relevant and the personproviding
the casemanagement
service the nature content units of the casemanagement
services received and whethergoals specified
in the careplan
have been achieved whether the individual has declined services in thecareplan
the need for andoccurrences of coordination with othercasemanagers the timeline forobtaining
needed services and a timeline for reevaluation of theplan
Pavment
Payment
forcasemanagement services underthe plan doesnotduplicate
payments made topublic agencies
orprivate
entities under other program authorities for thissamepurpose TN No 08 008 FEB 2 0 2009
Approval
DateSupersedes
TN No 06 002 Effective Date JUL e 1 1Case
management providers
arepaid
on aunit of service basis that does not exceed 15 minutes A detaileddescription
of the reimbursementmethodology identifying
the data used todevelop
therate is included in Attachment419BLimitations
Case
Management
doesnot include thefollowing
Case
management
activities thatare anintegral
component of another covered Medicaid serviceThe direct
delivery
ofanunderlying
medical educational social orother service towhich aneligible
individual has been referredActivities
integral
tothe administration of foster care programsActivities for which an individual may be
eligible
thatareintegral
to the administration of another non medical programexcept
for casemanagement
that is included in anindividualized education program orindividualizedfamily
serviceplan
consistent with section 1903c of the SocialSecurity
ActTN No 08 008
Supersedes
TN No 06 002JUL 0 1 Z008