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37.86.3506    CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, SERVICE REQUIREMENTS

(1) Individuals receiving case management services are allowed the free choice of any qualified Medicaid provider when obtaining case management services. An individual cannot be compelled to receive case management services.

(2) Case management services cannot restrict an individual's access to other Medicaid services.

(3) Case management services will not duplicate payments made to public agencies or private entities under the Medicaid program and other program authorities.

(4) A provider may not condition receipt of case management services on the receipt of other Medicaid services, or condition receipt of other Medicaid services on receipt of case management services.

(5) Case management services must be supported by narrative documentation of all services provided.

(6) Case management services for adults with severe disabling mental illness must be provided according to a case management plan which must:

(a) be developed jointly by the case manager and the client;

(b) identify measurable objectives;

(c) specify strategies to achieve defined objectives;

(d) identify agencies and contacts which will assist in meeting the objectives;

(e) identify natural and community supports to be utilized and developed; and

(f) include an objective to serve the client in the least restrictive and most culturally appropriate therapeutic environment possible for the client which is also directed toward facilitating preservation of the client in the family unit, or preventing out-of-community placement or facilitating the client's return from acute or residential psychiatric care.

(7) Objectives in a case management plan must have an identified date of review no more than 90 days after the plan date. Plans will be revised to reflect changes in client goals and needs, and the services provided to the client.

(8) Case management services for adults with severe disabling mental illness must be delivered in accordance with the individual recipient's needs.

(9) Case management services must be provided on a one-to-one basis, to an individual by one case management provider.

(10) Providers of case management services are prohibited from exercising the agency authority to authorize or deny the provision of other services under Medicaid.

(11) Case management providers must maintain case records that document for all individuals receiving case management services as follows:

(a) the name of the individual;

(b) the dates of the case management services;

(c) the time of services;

(d) the name of the provider agency and the person providing the case management services;

(e) the nature, content, units of the case management services received, and whether the goals specified in the case plan have been achieved;

(f) whether the individual has declined services in the care plan;

(g) the need for, and occurrences of, coordination with case managers of other programs;

(h) a timeline for obtaining needed services; and

(i) a timeline for reevaluation of the plan.

(12) Providers must also meet recording requirements as identified in ARM 37.85.414 and 37.85.410.

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2010 MAR p. 424, Eff. 2/12/10.

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