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STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM. State of Colorado

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Taraet Group

Targeted

case

management

services will be

provided

to alcohol orother

drug dependent

Medicaid clients who need assistance in

obtaining

necessary social educational

vocational and other services

Areas ofstate in which services will be provided

x Entire State

Only

in the

following geographic

areas

authority

of section 1915 g 1 of the Act is invoked to

provide

services less than Statewide

Comparabilitv of services

2L Services are

provided

in accordance with section 1902 a 10 8 of the Act Services arenot

comparable

in amountduration and scope

Definition of services

Case managementservices areservices furnished to assist individuals

eligible

under the State Plan in

gaining

accessto needed medical social educational and other

services Case

Management

includes the

following

assistance

Comprehensive

assessment and

periodic

reassessmentof individual needstodetermine the need for any medical educational socialor other services These assessment activities include

taking

client

history

identifying

the individuals needs and

completing

related documentation and

gathering

information from other sources suchas

family

members medical

providers social workers and educators if necessary toform a

complete

assessment of the individual

TN No 08 008

Supersedes

TN No 06 002

iJUL l 1 2Ul

(2)

Development

and

periodic

revision ofa

specific

care

plan

that is basedonthe information collected

through

theassessment

specifies

the

goals

and actionsto address the medical social educational and other services needed

by

the individual

includes activities such as

ensuring

the active

participation

of the

eligible

individual and

working

with the individual orthe individual s authorized health care decision maker and others to

develop

those

goals

and

identifies a course of actionto

respond

to the assessed needs of the

eligible

individual

Referral and related activities

to

help

an

eligible

individual obtain needed services

including

activities that

help

link anindividual with

o medical social educational

providers

or

o other programs and services that are

capable

of

providing

needed services suchas

making

referrals to

providers

for needed services and

scheduling appointments

for the individual

Monitoring

and follow up activities

activities and contacts thatarenecessary toensurethe care

plan

is

implemented

and

adequately

addresses the individuals needs and which may be with the individual

family

members

providers

or other entitiesorindividuals and conducted as

frequently

as necessary and

including

atleastone annual

monitoring

todetermine whether the

following

conditions are met

o services are

being

furnished in accordance with the individuals care

plan

o services in the care

plan

are

adequate

and

o there are

changes

in the needsorstatusof the individual and ifso

making

necessary

adjustments

in the care

plan

and servicearrangements with

providers

TN No 08 008

Supersedes

TN No 06 002

Approval

Date FEe z 0 2009 Effective Date

(3)

Case

management

may include contacts with non

eligible

individuals thatare

directly

related to

identifying

the needs and supports for

helping

the

eligible

individualto access services

Qualifications of providers

Approved

services must be

provided

and recommended

by

a

practitioner

that offers a substance abuse

specialty

Services will be offered in facilities that have been licensed

by

the Alcohol and

Drug

Abuse Division ADAD of the

Department

of Human Services or

by physicians

orother identified licensed

practitioners

of the

healing

arts licensed and certified

by Department

of

Regulatory Agencies

DORA or

nationally

licensed and certified

by

the National Association of Alcohol and

Drug

Abuse Counselors NAADAC the American

Society

of Addiction Medicine ASAM orthe American Board of

Psychiatry

and

Neurology

ABPN Freedom of choice

The Stateassuresthat the

provision

ofcase

management

services will not restrict an individualsfree choice of

providers

in violation of section 1902 a 23 of the Act

1

Eligible recipients

will have free choice of the

providers

ofcase

management

services within the

specified geographic

area identified in this

plan

2

Eligible recipients

willhave free choice of the

providers

of other medical care under the

plan

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 condition

receipt

ofcasemanagement services onthe

receipt

of other

TN No 08 008

Supersedes

TNNo 06 002

(4)

Medicaid services orcondition

receipt

of other Medicaid serviceson

receipt

ofcase

managementservices

The State assuresthat individuals will receive

comprehensive

case

management

services on a one to one basis

through

one case manager

The Stateassures that

providers

ofcase

management

services do not exercise the agencys

authority

toauthorizeor

deny

the

provision

of other services under the

plan

The Stateassures thatcase

management

is

only provided by

and reimbursed to

community

case

management providers

The Stateassuresthat Federal Financial

Participation

is

only

available to

community

providers

and will notbe claimedon behalf ofan individual until

discharge

from the medical institution and enrollment in

community

services

Case Records

Providers maintain case records that document for all individuals

receiving

case

managementthe

following

the name of the individual dates of the case

management

services the name of the

provider

agency if relevant and the person

providing

the case

management

service the nature content units of the case

management

services received and whether

goals specified

in the care

plan

have been achieved whether the individual has declined services in thecare

plan

the need for andoccurrences of coordination with othercasemanagers the timeline for

obtaining

needed services and a timeline for reevaluation of the

plan

Pavment

Payment

forcasemanagement services underthe plan doesnot

duplicate

payments made to

public agencies

or

private

entities under other program authorities for thissame

purpose TN No 08 008 FEB 2 0 2009

Approval

Date

Supersedes

TN No 06 002 Effective Date JUL e 1 1

(5)

Case

management providers

are

paid

on aunit of service basis that does not exceed 15 minutes A detailed

description

of the reimbursement

methodology identifying

the data used to

develop

therate is included in Attachment419B

Limitations

Case

Management

doesnot include the

following

Case

management

activities thatare an

integral

component of another covered Medicaid service

The direct

delivery

ofan

underlying

medical educational social orother service towhich an

eligible

individual has been referred

Activities

integral

tothe administration of foster care programs

Activities for which an individual may be

eligible

thatare

integral

to the administration of another non medical program

except

for case

management

that is included in anindividualized education program orindividualized

family

service

plan

consistent with section 1903c of the Social

Security

Act

TN No 08 008

Supersedes

TN No 06 002

JUL 0 1 Z008

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