Case Management

2 Case Management Defined Assists an individual in gaining and coordinating access to necessary care and services appropriate to the individual’s needs Assists an individual in gaining and coordinating access to necessary care and services appropriate to the individual’s needs May not be provided in excess of 8 hours per individual per day May not be provided in excess of 8 hours per individual per day

3 Two Types Routine Routine For an adult, a child, or adolescent, which is primarily site-based For an adult, a child, or adolescent, which is primarily site-based Intensive Intensive For a child or adolescent, which is primarily community-based For a child or adolescent, which is primarily community-based

4 Case Manager Responsibilities: Routine Case Management Meet face-to-face with individual, and the individual’s LAR or primary caregiver if individual is a child or adolescent, within 14 days after the case manager is assigned or document why meeting did not occur Meet face-to-face with individual, and the individual’s LAR or primary caregiver if individual is a child or adolescent, within 14 days after the case manager is assigned or document why meeting did not occur

5 Case Manager Responsibilities: Routine Case Management (cont.) Meet face-to-face with individual, upon the request of the individual, the LAR, or the primary caregiver at the case manager’s work site or document why the meeting did not occur Meet face-to-face with individual, upon the request of the individual, the LAR, or the primary caregiver at the case manager’s work site or document why the meeting did not occur

6 Case Manager Responsibilities: Routine Case Management (cont.) Assist the individual in identifying the immediate need of the individual in gaining access to community resource that may address identified need Assist the individual in identifying the immediate need of the individual in gaining access to community resource that may address identified need Document identified need and assistance given to address the need Document identified need and assistance given to address the need

7 Case Manager Responsibilities: Routine Case Management (cont.) If notified that the individual is in crisis, coordinate with appropriate providers of emergency services to respond to the crisis If notified that the individual is in crisis, coordinate with appropriate providers of emergency services to respond to the crisis

8 Case Manager Responsibilities: Intensive Case Management Meet face-to-face with individual, and the individual’s LAR or primary caregiver if individual is a child or adolescent, within 7 days after the case manager is assigned or within 7 days after discharge from an inpatient psychiatric setting, whichever is later or document the reasons why meeting did not occur Meet face-to-face with individual, and the individual’s LAR or primary caregiver if individual is a child or adolescent, within 7 days after the case manager is assigned or within 7 days after discharge from an inpatient psychiatric setting, whichever is later or document the reasons why meeting did not occur

9 Case Manager Responsibilities: Intensive Case Management (cont.) Meet face-to-face with the individual and the individual’s LAR or primary caregiver: Meet face-to-face with the individual and the individual’s LAR or primary caregiver: In accordance with the individual’s MH plan or document why the meeting did not occur In accordance with the individual’s MH plan or document why the meeting did not occur At their request or document why the meeting did not occur At their request or document why the meeting did not occur Upon notification of a clinically significant change in the individual’s functioning, life status, or service needs or document why the meeting did not occur Upon notification of a clinically significant change in the individual’s functioning, life status, or service needs or document why the meeting did not occur

10 Case Manager Responsibilities: Intensive Case Management (cont.) Gather information regarding individual’s strengths and service needs across life domains from relevant sources, including: Gather information regarding individual’s strengths and service needs across life domains from relevant sources, including: Individual Individual Individual’s LAR or primary caregiver Individual’s LAR or primary caregiver Other agencies & organizations providing services Other agencies & organizations providing services Individual’s clinical record Individual’s clinical record Other sources identified by LAR or primary caregiver Other sources identified by LAR or primary caregiver

11 Case Manager Responsibilities: Intensive Case Management (cont.) Utilize wraparound planning to develop a case management plan that addresses the individual’s unmet needs across life domains, including: Utilize wraparound planning to develop a case management plan that addresses the individual’s unmet needs across life domains, including: Prioritized list on unmet needs Prioritized list on unmet needs Description of objective and measurable outcome for each need Description of objective and measurable outcome for each need Description of actions that will be taken to achieve outcomes Description of actions that will be taken to achieve outcomes List of necessary services and service providers List of necessary services and service providers Description of Case Management services to be provided Description of Case Management services to be provided Statement of maximum period of time between face-to-face contacts Statement of maximum period of time between face-to-face contacts

12 Case Manager Responsibilities: Intensive Case Management (cont.) Assist individual in gaining access to needed services and service providers including: Assist individual in gaining access to needed services and service providers including: Referrals to potential service providers Referrals to potential service providers Initiating contact with potential service providers Initiating contact with potential service providers Arranging initial meetings & non-routine appointments Arranging initial meetings & non-routine appointments Arranging transportation to ensure attendance Arranging transportation to ensure attendance Advocating with service providers Advocating with service providers Providing relevant information to service providers Providing relevant information to service providers

13 Case Manager Responsibilities: Intensive Case Management (cont.) Monitor individual’s progress toward outcomes in case management plan Monitor individual’s progress toward outcomes in case management plan Gather information from all sources Gather information from all sources Review pertinent documentation Review pertinent documentation Ensure implementation of case management plan Ensure implementation of case management plan Ensure needed services were provided Ensure needed services were provided Determine progress toward desired outcomes Determine progress toward desired outcomes Identify barriers to accessing services or to obtaining maximum benefit from services Identify barriers to accessing services or to obtaining maximum benefit from services

14 Case Manager Responsibilities: Intensive Case Management (cont.) Identifying emerging unmet service needs Identifying emerging unmet service needs Determining if the MH case management plan needs to be modified to address the individual’s unmet service needs more adequately and revise plan to address modifications Determining if the MH case management plan needs to be modified to address the individual’s unmet service needs more adequately and revise plan to address modifications If notified that the individual is in crisis, coordinate with appropriate providers of emergency services to respond to the crisis If notified that the individual is in crisis, coordinate with appropriate providers of emergency services to respond to the crisis Recognize that the LAR is authorized to act on behalf of the child or adolescent Recognize that the LAR is authorized to act on behalf of the child or adolescent Advocating for the modification of services to address changes in the needs or status of the individual Advocating for the modification of services to address changes in the needs or status of the individual

15 Case Manager Responsibilities A case management must notify an individual in writing of the process for making a complaint to the client rights officers of the provider and the department if the individual expresses dissatisfaction with: A case management must notify an individual in writing of the process for making a complaint to the client rights officers of the provider and the department if the individual expresses dissatisfaction with: Scheduling meetings with the case manager, or Scheduling meetings with the case manager, or His or her MH case management plan or the treatment planning process His or her MH case management plan or the treatment planning process

16 Case Management Fair Hearings Any Medicaid eligible individual whose request for services is denied or is not acted upon with reasonable promptness, or whose MH case management services have been terminated, suspended, or reduced by the department is entitled to a fair hearing Any Medicaid eligible individual whose request for services is denied or is not acted upon with reasonable promptness, or whose MH case management services have been terminated, suspended, or reduced by the department is entitled to a fair hearing

17 Service Limitations Case Manager may not provide MH case management services to his or her: Case Manager may not provide MH case management services to his or her: Child Child Parent Parent Spouse Spouse Mother-in-law or Father-in-law Mother-in-law or Father-in-law Son-in-law or Daughter-in-law Son-in-law or Daughter-in-law Stepchild or Stepparent Stepchild or Stepparent Grandchild or Grandchild or Sibling (Brother or Sister) Sibling (Brother or Sister)

18 NON Case Management Activities Activities that do not assist an individual in gaining or coordinating access to needed services, such as: Activities that do not assist an individual in gaining or coordinating access to needed services, such as: Merely accompanying an individual to: Merely accompanying an individual to: A social or recreational event or other entertainment A social or recreational event or other entertainment Locations to conduct the individual’s personal affairs Locations to conduct the individual’s personal affairs Merely helping individual with domestic or financial affairs Merely helping individual with domestic or financial affairs

19 NON Case Management Activities Performing activity that is an integral and inseparable part of a service other than MH case management Performing activity that is an integral and inseparable part of a service other than MH case management Conducting skills training Conducting skills training Arranging medical referral from physician’s appointment Arranging medical referral from physician’s appointment Providing counseling or therapy Providing counseling or therapy Providing crisis services Providing crisis services Developing treatment plan for non MH Case Management services Developing treatment plan for non MH Case Management services Administering an assessment for a service other than MH case management Administering an assessment for a service other than MH case management

20 NON Case Management Activities Providing medical or nursing services, such as: Providing medical or nursing services, such as: Taking temperature or vital signs Taking temperature or vital signs Consulting between medical professionals Consulting between medical professionals Refilling individual’s prescription Refilling individual’s prescription Performing pre-admission or intake activities Performing pre-admission or intake activities

21 NON Case Management Activities Providing services to the LAR or primary caregiver, such as: Providing services to the LAR or primary caregiver, such as: Assisting person to access services to address their own (primary caregiver/LAR) needs Assisting person to access services to address their own (primary caregiver/LAR) needs Teaching parenting skills Teaching parenting skills Helping the person (primary caregiver/LAR) find employment Helping the person (primary caregiver/LAR) find employment Transporting the individual, the individual’s LAR or primary caregiver Transporting the individual, the individual’s LAR or primary caregiver

22 NON Case Management Activities Monitoring the individual’s general health status when such information is not required to gain access or coordinate needed services, such as: Monitoring the individual’s general health status when such information is not required to gain access or coordinate needed services, such as: Inquiring about individual’s general well- being Inquiring about individual’s general well- being Monitoring individual’s self- administration of medications Monitoring individual’s self- administration of medications Monitoring physical safety of individual Monitoring physical safety of individual

23 NON Case Management Activities Performing outreach activities to inform public of MH case management services that are available or to locate individuals who are potentially Medicaid eligible Performing outreach activities to inform public of MH case management services that are available or to locate individuals who are potentially Medicaid eligible Performing quality oversight of a service provider Performing quality oversight of a service provider Conducting utilization review activities Conducting utilization review activities Authorizing services Authorizing services

24 Texas Information and Referral Network (TIRN) Children’s Case Managers must have access and use the Texas Information and Referral Network (TIRN) Children’s Case Managers must have access and use the Texas Information and Referral Network (TIRN) This Internet Site contains basic information on more than 200 community based health and human service programs This Internet Site contains basic information on more than 200 community based health and human service programs

25 Texas Information and Referral Network (TIRN) For easy access, the Texas Information and Referral Network (TIRN) website is located on the HCCMHMRC Intranet For easy access, the Texas Information and Referral Network (TIRN) website is located on the HCCMHMRC Intranet Go to “Links” and click on Case Management State Resource Directory Go to “Links” and click on Case Management State Resource Directory Or call 211 and be connected directly to your local Area Information Center Or call 211 and be connected directly to your local Area Information Center

26 Documentation A Case Manager must document: A Case Manager must document: The provision of MH case Management services, as well as attempts to provide MH case management services The provision of MH case Management services, as well as attempts to provide MH case management services Referrals made and the disposition of each referral Referrals made and the disposition of each referral

27 Documentation: Face-to-face Service Date of contact Date of contact Start & stop time of contact Start & stop time of contact Description of service provided Description of service provided Individual’s response to service Individual’s response to service Case Manager’s signature Case Manager’s signature CredentialsQMHP-CS CredentialsQMHP-CS

28 Documentation: Face-to-face Service (cont.) For intensive case management, the progress or lack of progress in addressing outcomes identified in case management treatment plan For intensive case management, the progress or lack of progress in addressing outcomes identified in case management treatment plan

29 Documentation: Non Face-to-face Service Date of service Date of service Description of service provided Description of service provided Person with whom contact made, if any Person with whom contact made, if any Outcome of service Outcome of service Case Manager’s signature Case Manager’s signature CredentialsQMHP-CS CredentialsQMHP-CS