Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 7 - Targeted Case Management › Chapter 103 - Core Elements › Section XV-10301 - Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
				  Medicaid-enrolled case management agencies are required to perform the
				  following core elements of case management services.
1. Case Management Intake. The purpose of
				  intake is to serve as an entry point for case management services and to gather
				  baseline information to determine the recipient's need, appropriateness,
				  eligibility and desire for case management.
2. Case Management Assessment. Assessment is
				  the process of gathering and integrating formal and informal information
				  regarding a recipient's goals, strengths, and needs to assist in the
				  development of a person centered comprehensive plan of care. The purpose of the
				  assessment is to assess the support needs of the recipient for the provision of
				  supports. The assessment shall be performed in the recipient's home or another
				  location that the recipient's family or legal guardian chooses.
3. Comprehensive Plan of Care Development.
				  The comprehensive plan of care (CPOC) is a written plan based upon assessment
				  data (which may be multidisciplinary), observations, and other sources of
				  information which reflect the recipient's needs, capacities, and priorities.
				  The CPOC attempts to identify the supports required and the resources available
				  to meet these needs.
a. The CPOC shall be
				  developed through a collaborative process involving the recipient, family or
				  legal guardian, case manager, other support systems, appropriate professionals,
				  and service providers. It shall be developed in the presence of the recipient;
				  therefore, it cannot be completed prior to a meeting with the recipient. The
				  recipient, family or legal guardian, case manager, support system, and
				  appropriate professional personnel shall be directly involved and agree to
				  assume specific functions and responsibilities.
b. For initial CPOCs for the Office for
				  Citizens with Developmental Disabilities (OCDD), the CPOC shall be completed
				  and submitted for approval within 60 calendar days of the referral for case
				  management services, and initial CPOCs for early and periodic screening,
				  diagnosis and treatment (EPSDT), the CPOC shall be completed and submitted
				  within 35 days.
4. Case
				  Management Linkage. Linkage is assignment of the case management agency (CMA)
				  to an individual. The CMA is responsible for the arranging of services agreed
				  upon with the recipient and identified in the CPOC. Upon the request of the
				  recipient or responsible party, attempts shall be made to meet service needs
				  with informal resources as much as possible.
5. Case Management Follow-Up/Monitoring.
				  Follow-up/monitoring is the mechanism used by the case manager to assure the
				  appropriateness of the CPOC. Through follow-up/monitoring activity, the case
				  manager not only determines the effectiveness of the CPOC in meeting the
				  recipient's needs, but identifies when changes in the recipient's status
				  necessitate a revision in the CPOC. The purpose of follow-up/monitoring
				  contacts is to determine:
a. if supports are
				  being delivered as planned;
b. if
				  supports are effective and adequate to meet the recipient's needs;
				  and
c. whether the recipient is
				  satisfied with the supports.
6. Case Management Reassessment. Reassessment
				  is the process by which the baseline assessment is reviewed and information is
				  gathered for evaluating and revising the overall CPOC. A complete review of the
				  CPOC shall be performed on a quarterly basis, at a minimum, to assure that the
				  goals and services are appropriate to the recipient's needs as identified in
				  the assessment/reassessment process. A reassessment is also required when a
				  major change occurs in the status of the recipient and/or his family or legal
				  guardian.
7. Case Management
				  Transition/Closure
a. Provided that the
				  recipient has satisfied the requirements of linkage under
				  §10301.A 4, discharge
				  from a case management agency shall occur when the recipient:
i. no longer requires services;
ii. desires to terminate services;
iii. becomes ineligible for services;
				  or
iv. chooses to transfer to
				  another case management agency.
b. The closure process shall ease the
				  transition to other services or care systems. The agency shall not retaliate in
				  any way against the recipient for terminating services or transferring to
				  another agency for case management services.