(1) Case management is the planning for, arranging for, implementation of, and monitoring of the delivery of services available through the program to a person.
(2) Case management services include:
(a) developing a plan of care for a person;
(b) monitoring and managing a plan of care for a person;
(c) establishing relationships and contracting with service providers and community resources;
(d) maximizing a person’s efficient use of services and community resources such as family members, church members, and friends;
(e) facilitating interaction among people working with a person;
(f) prior authorizing the provision of all services; and
(g) managing expenditures.
(3) A case management team must consist of:
(a) a registered nurse with experience on a case management team serving persons through a program of home and community-based services for the elderly and persons with physical disabilities, or severe disabling mental illness; and
(b) a social worker with two consecutive years experience providing case management services to adults with severe disabling mental illness.
(4) The case management team must:
(a) be a legal entity contractually retained by the department to provide Medicaid funded home and community case management services to persons who are elderly or who have physical disabilities;
(b) function as directed by the department;
(c) assure that services provided to recipients are of appropriate quality and cost effective;
(d) provide case management services to no more than the number of persons specified by the department;
(e) manage expenditures within the allocated monies; and
(f) meet the department’s reporting requirements.