Case Management 101 for Disability Service Division Programs

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Case Management 101 for Disability Service
Division Programs

• Department of Human Services
• Disability Services Division

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Objectives

• Develop an understanding of State and County role
  in providing case management to persons with
  disabilities
• Understand the basic case management
  responsibilities from assessment/screening to
  service plan monitoring
• Increase knowledge of case manager role in
• Coordinating individual planning
• Helping individuals identify desired outcomes to
  include in written support plan
• Assuring health and safety
• Monitoring and evaluating services

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Types of Case Management

• Rule 185
• VA/DD TCM
• MH TCM
• RSC
• CW-TCM
• Waiver (CAC, CADI, DD, TBI)

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Assurances

• Level of Care (LOC)
• Service Plan/Care Plan
• Qualified Providers
• Health and Safety
• Administrative Authority
• Financial Accountability

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Waiver Case Management

• Waiver Case Management Entails
• Development of a community support plan
• Informing the person or persons legal guardian,
  or parent of minor, of service options
• Assisting person to identify potential providers
• Assisting person to access services
• Coordination of services
• Evaluation monitoring of services identified in
  plan
• Annual review of community support plan

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Delegation of CAC, CADI, or TBI Waiver Case
Management Activities

• CM may delegate some aspects of case management
  activities with oversight by CM
• CM may not delegate those aspects which require
  professional judgment
• Assessments
• Reassessments
• Care plan development

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Administrative Activities

• Administrative activities are not billable under
  any of the waivers
• Intake
• Diagnosis (DD/MH)
• Screening/Assessment
• Service authorization
• Review of eligibility/level of care
• Appeals and conciliations

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Timelines

• CAC, CADI, and TBI
• Completion of LTCC within 10 working days of
  request for assessment
• Written service plan within 10 days after LTCC is
  completed
• Annual review of service plan
• Turning 65 screenings

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Timelines

• Rule 185
• Case manager designated within 10 working days of
  application
• Diagnostic assessment within 35 days of receipt
  of application
• Screen within 60 days of request for service or
  within 5 days of an emergency admission to ICF/MR
  and crisis respite
• Annual Full team screening (if required) or
  Annual Review

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Service Activities

• Development of a support plan
• Informing person/legal rep about options
• Provider person/legal rep a list of qualified
  providers
• Assisting person to access services
• Coordinating services
• Monitoring and evaluating services in plan
• Annual review of support plan (reflect any
  changes in persons needs)

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Case Management is the BIG Picture!

• Developing a support plan requires that case
  managers be knowledgeable about
• CMS Requirements
• State Responsibilities
• County Responsibilities
• Case Manager and PHN Responsibilities

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When Does Case Management Start?What Does the
Case Manager Do?

• Starts after case management eligibility has been
  determined
• Begins with person-centered planning
• Involves helping people to
• Access needed services,
• Coordinate needed services,
• Monitor how services are provided,
• Evaluate quality of service

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Person Centered Planning

• A set of support planning strategies that focus
  on the person rather than programs
• Can occur both formally and informally
• A process driven by the individual
• A perspective that recognizes capacities and
  builds on them
• Is a team effort so make sure that the process
  involves the right people

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Person Centered Practices

• Help the person identify a future vision
• Recognize barriers to achieving goals
• Establish and strengthen circles of support
• Develop an individualized plan for achieving
  desired outcomes
• Balances the needs and wishes of the person into
  one comprehensive support plan

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Service Plan Development Process

• Service plan development process includes
• Developing a support plan
• Assuring participation in process,
• Reviewing all types of assessments (PCA, DD,
  LTCC, intellectual functioning, adaptive
  behavior, communication, mobility, etc.)
• Assuring informed choice,
• Identification of desired outcomes, needs, and
  preferences in the plan

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Additional Requirements for Rule 185

• Identification of long and short range goals for
  the person
• Other services needed but not available
• Addressing the need for residential habilitation

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Service Plan Development

• The case manager
• is responsible for implementation and monitoring
• makes sure health care needs are addressed
• coordinates waiver, state plan, other services
• identifies amount, frequency, and duration of
  services
• identifies all needed services in the plan

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Health and Safety

• Does plan ensure that person is protected from
  and recognizes abuse, neglect, and exploitation?
• How are risks assessed?
• Are risk management strategies incorporated into
  plan in a manner sensitive to persons
  preferences?
• Is there a back-up plan?
• Are emergency contacts listed?

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CMS Requirements for Health and Safety Assurance

• Reporting critical events or incidents
• Training and education concerning abuse, neglect,
  and exploitation
• Behavioral safeguards for use of restraints and
  restrictive intervention
• Medication administration and management

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Personal Risk Negotiation

• The service plan
• reflects the consumers choices
• balances assessed service needs and desired level
  of independence

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Service Plan Implementation

• What entities are responsible for plan
  implementation?
• What are their responsibilities?
• What are the service plan documentation
  requirements?

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Support Plan Monitoring-You are the one!

• Paid and unpaid providers should be designated in
  the support plan
• Case manager must conduct face-to-face visits at
  least semi-annually
• Service plan review and update should be
  completed annually and whenever significant
  changes occur for the individual

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Support Plan Monitoring Methods and Frequency

• Are services furnished in accordance with the
  support plan?
• Do participants access services identified in the
  plan?
• Do participants exercise informed choice of
  vendor?
• Do services meet participant needs?
• Are back-up plans effective?
• Is emergency contact information current and
  correct?

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Support Plan Monitoring Methods and Frequency
(continued)

• Do plans assure health and safety?
• Do persons access all services included in their
  support plan?
• Is there a method for prompt follow up and
  remediation of identified problems?
• What happens to information collected during
  monitoring?

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Monitoring and Evaluation Activities

• Must result in a determination that
• Services implemented are consistent with persons
  plan and are directed at achieving desired
  outcomes
• Providers are fulfilling their responsibilities
• The persons health and safety are assured
• The persons civil and legal rights are protected
• The person and the persons legal rep
  satisfaction with the services is addressed

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Monitoring Checklist

• Visit the individual
• Visit the service sites while services are being
  provided to verify service delivery
• Review the provider records during the monitoring
  visit
• Observe implementation of services that address
  desired outcomes
• Compile, review, and analyze periodic evaluations
  and reports
• Revise the service plan as needed

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Documentation of Monitoring

• Document in case notes all activities and
  findings (SSIS or other data base)
• Documentation in the case notes supports billing
  for case management services
• What do you include in the case notes?
• Documentation may be requested for auditing
  purposes eg., PERM project, OLA, OIG, and CMS
  waiver reviews

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Case Management Summary

• County Case Managers Responsibilities
• Person Centered Planning Principles
• Health and Safety / Risk Negotiation
• Service Plan Development, Coordination and
  Implementation
• Service Plan Monitoring and Evaluation
• Documentation of Case Management Activities

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Waiver Review Project

• Document assurances to CMS
• Monitor compliance with federal and state
  requirements
• Identify promising practices that assure quality
• Provide DHS with information for making
  recommendations and developing requirements
• Goal is to complete reviews in all lead agencies
  by 2011

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Sources of Information for Case Managers

• Disability Services Program Manual
• DSD H-C Policy Quest
• Regional Resource Specialists
• County Waiver Reviews
• Licensing Reviews
• State Rules and Statutes
• Minnesota Health Care Provider Manual