qualified community care case manager

(2) “Qualified community care case manager” defined In this section, the term “qualified community care case manager” means a nonprofit or public agency or organization which— (A) has experience or has been trained in establishing, and in periodically reviewing and revising, individual community care plans and in the provision of case management services to the elderly; (B) is responsible for (i) assuring that home and community care covered under the State plan and specified in the ICCP is being provided, (ii) visiting each individual’s home or community setting where care is being provided not less often than once every 90 days, and (iii) informing the elderly individual or primary caregiver on how to contact the case manager if service providers fail to properly provide services or other similar problems occur; (C) in the case of a nonpublic agency, does not provide home and community care or nursing facility services and does not have a direct or indirect ownership or control interest in, or direct or indirect affiliation or relationship with, an entity that provides, home and community care or nursing facility services; (D) has procedures for assuring the quality of case management services that includes a peer review process; (E) completes the ICCP in a timely manner and reviews and discusses new and revised ICCPs with elderly individuals or primary caregivers; and (F) meets such other standards, established by the Secretary, as to assure that— (i) such a manager is competent to perform case management functions; (ii) individuals whose home and community care they manage are not at risk of financial exploitation due to such a manager; and (iii) meets such other standards as the State may establish. The Secretary may waive the requirement of subparagraph (C) in the case of a nonprofit agency located in a rural area.


42 USC § 1396t(d)(2)

Scoping language

In this section
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