case management services

(2) For purposes of this subsection: (A) (i) The term “case management services” means services which will assist individuals eligible under the plan in gaining access to needed medical, social, educational, and other services. (ii) Such term includes the following: (I) Assessment of an eligible individual to determine service needs, including activities that focus on needs identification, to determine the need for any medical, educational, social, or other services. Such assessment activities include the following: (aa) Taking client history. (bb) Identifying the needs of the individual, and completing related documentation. (cc) Gathering information from other sources such as family members, medical providers, social workers, and educators, if necessary, to form a complete assessment of the eligible individual. (II) Development of a specific care plan based on the information collected through an assessment, that specifies the goals and actions to address the medical, social, educational, and other services needed by the eligible individual, including activities such as ensuring the active participation of the eligible individual and working with the individual (or the individual’s authorized health care decision maker) and others to develop such goals and identify a course of action to respond to the assessed needs of the eligible individual. (III) Referral and related activities to help an individual obtain needed services, including activities that help link eligible individuals with medical, social, educational providers or other programs and services that are capable of providing needed services, such as making referrals to providers for needed services and scheduling appointments for the individual. (IV) Monitoring and followup activities, including activities and contacts that are necessary to ensure the care plan is effectively implemented and adequately addressing the needs of the eligible individual, and which may be with the individual, family members, providers, or other entities and conducted as frequently as necessary to help determine such matters as— (aa) whether services are being furnished in accordance with an individual’s care plan; (bb) whether the services in the care plan are adequate; and (cc) whether there are changes in the needs or status of the eligible individual, and if so, making necessary adjustments in the care plan and service arrangements with providers. (iii) Such term does not include the direct delivery of an underlying medical, educational, social, or other service to which an eligible individual has been referred, including, with respect to the direct delivery of foster care services, services such as (but not limited to) the following: (I) Research gathering and completion of documentation required by the foster care program. (II) Assessing adoption placements. (III) Recruiting or interviewing potential foster care parents. (IV) Serving legal papers. (V) Home investigations. (VI) Providing transportation. (VII) Administering foster care subsidies. (VIII) Making placement arrangements. (B) The term “targeted case management services” are case management services that are furnished without regard to the requirements of section 1396a(a)(1) of this title and section 1396a(a)(10)(B) of this title to specific classes of individuals or to individuals who reside in specified areas.


42 USC § 1396n(g)(2)

Scoping language

For purposes of this subsection
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