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 12VAC30-50-470 - Case management for recipients of auxiliary grants

Current through Register Vol. 40, No. 24, July 15, 2024
A. Target group. Recipients of optional state
				  supplements (auxiliary grants) as defined in
				  12VAC30-40-350 (Attachment 2.6 B),
				  who reside in licensed adult care residences.
B. Services will be provided in the entire
				  state.
C. Services are not
				  comparable in amount, duration, and scope. Authority of § 1915(g)(1) of
				  the Act is invoked to provide services without regard to the requirements of
				  § 1902(a)(10)(B) of the Act.
D. Definition of services. The case
				  management services will provide assessment, service location, coordination and
				  monitoring for aged, blind and disabled individuals who are applying for or
				  receiving an optional state supplement (auxiliary grant) to pay the cost of
				  residential or assisted living care in a licensed adult care residence in order
				  to facilitate access to and receipt of the most appropriate placement. In
				  addition, the case management services will provide for periodic reassessment
				  to determine whether the placement continues to meet the needs of the recipient
				  of optional state supplement (auxiliary grant) and to arrange for transfer to a
				  more appropriate placement or arrange for supplemental services as the needs of
				  the individual change.
E.
				  Qualifications of providers. A qualified case manager for recipients of
				  auxiliary grants must be a qualified employee of a human service agency as
				  required in § 63.1-25.1 of the Code of Virginia. To qualify as a provider
				  of case management for auxiliary grant recipients, the human service agency:
1. Must employ or contract for case managers
				  who have experience or have been trained in establishing, and in periodically
				  reviewing and revising, individual community care plans and in the provision of
				  case management services to elderly persons and to disabled adults;
2. Must have signed an agreement with the
				  Department of Medical Assistance Services to deliver case management services
				  to aged, blind and disabled recipients of optional state supplements (auxiliary
				  grants);
3. Shall have written
				  procedures for assuring the quality of case management services; and
4. Must ensure that claims are submitted for
				  payment only when the services were performed by case managers meeting these
				  qualifications. The case manager must possess a combination of work experience
				  in human services or health care and relevant education which indicates that
				  the individual possesses the following knowledge, skills, and abilities at
				  entry level. These must be documented on the job application form or supporting
				  documentation.
a. Knowledge of:
(1) Aging;
(2) The impact of disabilities and illnesses
				  on elderly and nonelderly persons;
(3) Conducting client assessments (including
				  psychosocial, health and functional factors) and their uses in care
				  planning;
(4) Interviewing
				  techniques;
(5) Consumers'
				  rights;
(6) Local human and health
				  service delivery systems, including support services and public benefits
				  eligibility requirements;
(7) The
				  principles of human behavior and interpersonal relationships;
(8) Effective oral, written, and
				  interpersonal communication principles and techniques;
(9) General principles of record
				  documentation; and
(10) Service
				  planning process and the major components of a service plan.
b. Skills in:
(1) Negotiating with consumers and service
				  providers;
(2) Observing, recording
				  and reporting behaviors;
(3)
				  Identifying and documenting a consumer's needs for resources, services and
				  other assistance;
(4) Identifying
				  services within the established services system to meet the consumer's
				  needs;
(5) Coordinating the
				  provision of services by diverse public and private providers; and
(6) Analyzing and planning for the service
				  needs of elderly or disabled persons.
c. Abilities to:
(1) Demonstrate a positive regard for
				  consumers and their families;
(2)
				  Be persistent and remain objective;
(3) Work as a team member, maintaining
				  effective inter- and intra-agency working relationships;
(4) Work independently, performing position
				  duties under general supervision;
(5) Communicate effectively, verbally and in
				  writing;
(6) Develop a rapport and
				  communicate with different types of persons from diverse cultural backgrounds;
				  and
(7) Interview.
d. Individuals meeting all the
				  above qualifications shall be considered a qualified case manager; however, it
				  is preferred that the case manager possess a minimum of an undergraduate degree
				  in a human services field, or be a licensed nurse. In addition, it is
				  preferable that the case manager have two years of experience in the human
				  services field working with the aged or disabled.
e. To obtain DMAS payment, the case
				  management provider must maintain in a resident's record a copy of the
				  resident's assessment, plan of care, all reassessments, and documentation of
				  all contacts, including but not limited to face-to-face contacts with the
				  resident, made in regard to the resident.