Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 107 - Covered Services › Section DHS 107.32 - Case management services

Current through June 24, 2024
(1) COVERED
				SERVICES.
(a)
General.
1. Case management services covered by MA are
				services described in this section and provided by an agency certified under s.
				DHS
				105.51 or by a qualified person under contract to an
				agency certified under s.
				DHS
				105.51 to help a recipient, and, when appropriate, the
				recipient's family gain access to, coordinate or monitor necessary medical,
				social, educational, vocational and other services.
2. Case management services under pars. (b)
				and (c) are provided under s.
				49.45(25),
				Stats., as benefits to those recipients in a county in which case management
				services are provided who are over age 64, are diagnosed as having Alzheimer's
				disease or other dementia, or are members of one or more of the following
				target populations: developmentally disabled, chronically mentally ill who are
				age 21 or older, alcoholic or drug dependent, physically or sensory disabled,
				or under the age of 21 and severely emotionally disturbed. In this subdivision,
				"severely emotionally disturbed" means having emotional and behavioral problems
				which:
a. Are expected to persist for at
				least one year;
b. Have
				significantly impaired the person's functioning for 6 months or more and,
				without treatment, are likely to continue for a year or more. Areas of
				functioning include: developmentally appropriate self-care; ability to build or
				maintain satisfactory relationships with peers and adults; self-direction,
				including behavioral controls, decisionmaking, judgment and value systems;
				capacity to live in a family or family equivalent; and learning ability, or
				meeting the definition of "child with exceptional educational needs" under ch.
				PI 1 and s.
				115.76(3),
				Stats.;
c. Require the person to
				receive services from 2 or more of the following service systems: mental
				health, social services, child protective services, juvenile justice and
				special education; and
d. Include
				mental or emotional disturbances diagnosable under DSM-III-R. Adult diagnostic
				categories appropriate for children and adolescents are organic mental
				disorders, psychoactive substance use disorders, schizophrenia, mood disorders,
				schizophreniform disorders, somatoform disorders, sexual disorders, adjustment
				disorder, personality disorders and psychological factors affecting physical
				condition. Disorders usually first evident in infancy, childhood and
				adolescence include pervasive developmental disorders (Axis II), conduct
				disorder, anxiety disorders of childhood or adolescence and tic disorders.
Note:
DSM-111-R is the 1987 revision of the 3rd
				  edition (1980) of the Diagnostic and Statistical Manual of Mental Disorders of
				  the American Psychiatric Association.
3. Case management services under par. (d)
				are available as benefits to a recipient identified in subd. 2. if:
a. The recipient is eligible for and
				receiving services in addition to case management from an agency or through
				medical assistance which enable the recipient to live in a community setting;
				and
b. The agency has a completed
				case plan on file for the recipient.
4. The standards specified in s.
				46.27, Stats., for
				assessments, case planning and ongoing monitoring and service coordination
				shall apply to all covered case management services.
Note:
Section
				  46.27, Stats., has
				  been repealed.