Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 50 - AMOUNT, DURATION, AND SCOPE OF MEDICAL AND REMEDIAL CARE SERVICES › Part IV - Eligibility Requirements › Section 12VAC30-50-415 - Case management for individuals receiving early intervention (Part C) services

Current through Register Vol. 40, No. 24, July 15, 2024
A. Target
				  group for early intervention case management. Medicaid eligible children from
				  birth up to three years of age who have (i) a 25% developmental delay in one or
				  more areas of development, (ii) atypical development, or (iii) a diagnosed
				  physical or mental condition that has a high probability of resulting in a
				  developmental delay who participate in the early intervention services system
				  described in Chapter 53 (§ 2.2-5300 et seq.) of Title 2.2 of the Code of
				  Virginia are the target group.
B.
				  Services are provided throughout the Commonwealth.
C. Services are not comparable in amount,
				  duration, and scope. The authority of § 1915(g)(1) of the Social Security
				  Act (the Act) is invoked to provide services without regard to the requirements
				  of § 1902(a)(10)(B) of the Act.
D. Definition of services. Early intervention
				  case management services are services furnished to assist individuals eligible
				  under the State Plan who reside in a community setting in gaining access to
				  medical, social, educational, and other services. Early intervention case
				  management includes the following assistance:
1. Comprehensive assessment and at least
				  annual reassessment of individual needs to determine the need for any medical,
				  educational, social, or other services, including EPSDT services.
2. Development and at least annual revision
				  of an individualized family service plan (IFSP) as defined in coverage of early
				  intervention services under Part C of Individuals with Disabilities Education
				  Act (IDEA) (12VAC30-50-131 ) based on the
				  information collected through the assessment. A face-to-face contact with the
				  child's family is required for the initial development and revision of the
				  IFSP. The case manager shall be responsible for determining if the family's
				  particular situation warrants additional face-to-face visits.
3. Referral and related activities to help
				  the eligible individual obtain needed services, including activities that help
				  link the individual with medical, social, and educational providers or other
				  programs and services that are capable of providing needed services to address
				  identified needs and achieve goals specified in the IFSP.
4. Monitoring and follow-up activities,
				  including activities and contacts that are necessary to ensure that the IFSP is
				  effectively implemented and adequately addresses the needs of the eligible
				  individual. At a minimum one telephone, email, or face-to-face contact shall be
				  made with the child's family every three calendar months, or attempts of such
				  contacts. This contact or attempted contact shall be documented. The case
				  manager shall be responsible for determining if the family's particular
				  situation warrants additional family contacts.
5. Early intervention case management
				  includes contacts with family members, service providers, and other noneligible
				  individuals and entities who have direct knowledge of the eligible individual's
				  needs and care.