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Case Management Training

Department of Medical Assistance Services. Case Management Training. Division of Long -Term Care Department of Medical Assistance Services 2012. http://dmasva.dmas.virginia.gov. 1. Case Management Definition Case Management Qualifications Team approach Trends seen by analysts .

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Case Management Training

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  1. Department of Medical Assistance Services Case Management Training Division of Long -Term Care Department of Medical Assistance Services 2012 http://dmasva.dmas.virginia.gov 1

  2. Case Management Definition Case Management Qualifications Team approach Trends seen by analysts Face to face and Quarterlies Interruptions and Extensions Transfers Housekeeping Tips Goals

  3. Goals cont. • Abuse and Neglect • Quality Management Reviews • Billing

  4. Case Management (CM)-Definition Activities designed to assist a child or adult with DD to live in the community by . . . accessing needed medical, psychiatric, social, educational, vocational, residential, institutional, and other supports

  5. Case Manager (CM) Qualifications • DMAS Participation Agreement • Developmental Disability work experience • CM and SF can be the same individual • Undergraduate degree in a Human Services field • Cannot be a direct service provider • Back-up Coverage 12VAC 30-50-490

  6. Case Manager (CM) Qualifications • Employed by an organization • Self-employed • Supervisor to Case Manager • CM provider cannot supervise another CM provider • Personnel Record • Eight Hours of Training

  7. Case Manager (CM) Qualifications • Parents, Spouses or any person living with the individual • CM cannot provide services to own child • CM may provide service facilitation(SF) 12VAC 30-50-490

  8. Case Management while on Wait list • Individual’swhohaveMedicaid • Documented in plan of care • Case Management Activities 12 VAC 30.50.490)

  9. The Team Approach to the Plan of Care Meeting Participant, Family, and Providers

  10. Satisfaction with services Health and safety Coordination Organized Unduplicated No breaks in service Optimal service delivery (DD Waiver Manual, Chapter IV) What does the Team approach ensure?

  11. Who does the case manager contact for a Plan of Care Meeting? • Participant and/or his/her family, • All current service providers and • Friend, Legal Guardian, significant other • Date/Time/Meeting location/advance notice (DD Waiver Manual, Chapter IV)

  12. What is the goal of the Plan of Care Meeting? • Person Centered • Decision-Making • Discuss concerns • Satisfaction with Services/Meeting needs (DD Waiver Manual, Chapter IV)

  13. What is the goal of the Plan of Care Meeting? • Short and Long-term goals • Focus of meeting • Target date • Effective and Consistent (DD Waiver Manual, Chapter IV)

  14. Case Management • What is Case Management? • Case Management activities include: • Assessing and planning • Linking • Coordinating • Monitoring/Follow up • Making Collateral Contacts • Advocating • Education and Counseling • Enhancing community integration (12 VAC 30.50.490)

  15. What are other important topics? • Freedom of Choice • Future planning: • Aging • Graduation/Transition Planning • Aging Caregiver • Behavioral/Crisis Planning • Contingency plans

  16. Choice of Services Why is choice important? • Empowering • In control of their lives • Helps CM to develop the POC Who makes the choice? • Is the participant over 18? • Does he/she have the ability to make their own choices? • Does he/she direct his own care? • Does he/she have a legal guardian?

  17. Resources to help with Choices Network with other Case Managers DMAS website Develop your own provider list for your families

  18. Trends Trends Seen By DD Waiver Analyst

  19. Trends Seen By Analysts • Level of Functioning Assessments • DMAS 456 • Social Assessment • DMAS 457 • DMAS 97 A/B • DMAS 99 • Environmental Modifications

  20. Trends Seen by Analysts • Assistive Technology • Consumer Directed and Agency Directed Companion • In-Home Residential • Therapeutic Consultation • Denial of Services

  21. How to reduce Trends • The key to successful plan submissions is error free work • Double check that no spaces are left blank and that the documentation matches the requested hours of service • Complete justification is required for requests for services including adding new services, increases or decreases in services and/or service hours

  22. How to reduce Trends Use the DD Waiver Fax Sheet • Please use the fax cover sheet • Identify the type of plan and include any special instructions you may have for DMAS • Resubmissions/Pend responses • Identify on the new fax sheet what your resubmission is addressing • Note when submitting a response to a pend you do not need to resubmit the entire packet. You only need to submit the information that is being requested on the Case Manager Status Report

  23. Face to Face Visits

  24. Face to Face Meetings • A face to face (FF) visit is defined as … the case manager or service provider must meet with the individual in person and that the individual should be engaged in the visit to the maximum extent possible. (12VAC30-120-700) • A face to face contact is required at a minimum of every 90 days. (Chapter IV, 12 VAC 30-50-490)

  25. Face to Face Meetings • Documentation Requirements: • FF with individual • Assessment of service satisfaction • Any unmet needs • Individual’s status • Service modification (DD Waiver Manual, Chapter IV)

  26. TIPS for FF • Case notes may be in the form of contact-by-contact entries or a monthly summary as long as they correspond with a contact log. These notes must include the date, type, and reason for each contact. • All entries must be signed (first initial and last name minimum) and dated. • Face to face visit notes are not quarterly reports and need to be documented separately.

  27. Case Management Review process

  28. Case Management Review At a minimum, every three months review: • Plan of care equals a FF with the individual • Quarterly goals and objectives to ensure they are being met, and • Any necessary modifications to the plan of care

  29. Case Management Review • At least once per plan of care year this review must occur in the individual’s home environment. (12VAC30-120-720.E.b.1-3c.)

  30. Why is this process separate from the face to face contact meetings? • Comprehensive evaluation must include the following: • The DMAS 457 support documentation which includes all of the individuals goals and objectives as agreed upon in the team meeting. • The plan of care which includes all DD waiver services including case management. • The service providers quarterly reports submitted to the case manager. (12VAC30.120.720.E.1.b)

  31. These are the required components for your Quarterly Report • Revisions to the Plan Of Care • General status • Significant events • Progress or lack of progress in goals • Satisfaction with Services and Case Management (DD Waiver Manual, Chapter IV)

  32. Quarterly Review • All service providers must complete a written semiannual report and forward to the case manager.

  33. Quarterly Review • Exception! When any sporadic and temporary services such as Respite, Assistive Technology, Environmental Modification, PERS and Crisis Stabilization are provided during the quarter, the case manager must obtain details of the services from those providers and include this information in the Quarterly report. (DD Waiver manual, Chapter IV)

  34. Goal and Objective Review • The Quarterly Review schedule is based on the start date of the POC. • Initial plan year view POC Start Date Quarterly Due Semi Annual Due Quarterly Due Jan 1, 201 April 1, 2012 July 1, 2012 October 1, 2012 Months 1 2 3 4 5 6 7 8 9 10 11 12

  35. Goal and Objective Review • Quarterly Reviews are planned around the POC start date. • Renewal Plan Year View Annual Plan Due Quarterly Review Semiannual Due Quarterly Due January 1, 2012 April 1, 2012 July 1, 2012 October 1,2012 Months 13 14 15 16 17 18 19 20 21 22 23 24

  36. Emergency Plans of Care (POC)

  37. Processing Plans of Care (POC) • Emergency plans What is considered an emergency? • It is at the discretion of DMAS staff whether a plan falls into the emergency criteria for a plan to be worked out of the normal work flow • When a Case Manager requests emergency consideration, a team review will take place prior to the deciding to work the plan

  38. Emergency (POC) • Most emergency plans are medical in nature • Poor planning on your part does not constitute an emergency

  39. Emergency (POC) • Examples of emergency plans: • A participant has broken her hip and needs additional hours of service • A participant is experiencing skin breakdown and needs additional hours • How do you define an emergency?

  40. Processing Emergency (POC) Crisis vs. Emergency • Crisis is defined as a mental health emergency • DMAS is required to review crisis plans as they are received so authorization can be obtained within 72 hours

  41. Interruptions and Extensions

  42. The difference between Extension Letters and Interruptions • Extensions are requested prior to beginning services • Interruptions are requested after the participant has started service and has not received services in thirty days

  43. When is an Extension letter needed? • When a participant is unable to initiate services within 60 calendar days of becoming Medicaid eligible and enrolled an extension letter is required (DD Waiver Manual, Chapter IV)

  44. What are the extension letter requirements? • Requests must be in writing • Letters must be received by DMAS within the 30 day period the extension is requested • No more than 4 extensions may be approved • Extension letters must contain the specific start and end dates for the requested time period • Extension letters must contain information why more time is needed to initiate waiver services (12VAC30-120-720.9.)

  45. When are plan interruptions needed? • When a participant has not received DD Waiver services for more than 30 days • It is the Case Manager’s responsibility to submit an Interruption POC to DMAS

  46. How do you interrupt a POC? • If possible, the Case Manager should meet with the participant and/or family member to obtain their signature on the Plan of Care • (Note: participants should be notified that services can only be interrupted for 90 days and then the withdrawal process will begin)

  47. How do you interrupt a POC? • At the top of the Plan of Care, the Case Manager should check the box for “Interruption” and update the DMAS 457 to explain why services are being interrupted then submit the documents to DMAS

  48. How do you restart a POC? • Meet with the participant and/or family and providers to discuss the POC • Resubmit the updated POC marked “Revision” with an updated 457 • The supporting documentation for the services being requested • Note: DMAS has the same work time for restarting a POC as regular plans that are submitted daily. (DD waiver manual, Chapter 4)

  49. Transferring Case Management Services

  50. Transfer of Case Management • If a participant wishes to “switch” to another case manager, the current CM is responsible for: • Send a Case Management list • Informing the participant that the Case Manager needs written permission to exchange information (a copy of your agency’s Consent Form) with the new case manager they have selected

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