12 Va. Admin. Code § 30-50-430 - Case management services for youth at risk of serious emotional disturbance
A.
Target group: Medicaid eligible individuals who meet the DBHDS definition of
youth at risk of serious emotional disturbance.
1. An active client shall mean an individual
for whom there is a plan of care in effect which requires regular direct or
client-related contacts or communication or activity with the client, family,
service providers, significant others and others including at least one
face-to-face contact every 90-days. Billing can be submitted for an active
client only for months in which direct or client-related contacts, activity or
communications occur. Authorization is required for Medicaid
reimbursement.
2. There shall be no
maximum service limits for case management services. Case management services
must not be billed for individuals who are in institutions for mental
disease.
B. Services
will be provided in the entire state.
C. Comparability of services: 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: Mental health
services. Case management services assist youth at risk of serious emotional
disturbance in accessing needed medical, psychiatric, social, educational,
vocational, and other supports essential to meeting basic needs. Services to be
provided include:
1. Assessment and planning
services, to include developing an Individual Service Plan;
2. Linking the individual directly to
services and supports specified in the treatment/services plan;
3. Assisting the individual directly for the
purpose of locating, developing or obtaining needed service and
resources;
4. Coordinating services
and service planning with other agencies and providers involved with the
individual;
5. Enhancing community
integration by contacting other entities to arrange community access and
involvement, including opportunities to learn community living skills, and use
vocational, civic, and recreational services;
6. Making collateral contacts which are
nontherapy contacts with an individual's significant others to promote
treatment and/or community adjustment;
7. Following up and monitoring to assess
ongoing progress and ensuring services are delivered; and
8. Education and counseling which guides the
client and develops a supportive relationship that promotes the service
plan.
E. Qualifications
of providers.
1. Services are not comparable
in amount, duration, and scope. Authority of § 1915(g)(1) of the Act is
invoked to limit case management providers, to the community services boards
only, to enable them to provide services to serious/chronically mentally ill or
mentally retarded individuals without regard to the requirements of §
1902(a)(10)(B) of the Act . To qualify as a provider of case management services
to youth at risk of serious emotional disturbance, the provider of the services
must meet the following criteria:
a. The
provider must meet state and federal requirements regarding its capacity for
administrative and financial management ;
b. The provider must document and maintain
individual case records in accordance with state and federal
requirements;
c. The provider must
provide services in accordance with the Virginia Comprehensive State Plan for
Mental Health, Mental Retardation and Substance Abuse Services;
d. The provider must be licensed as a
provider of case management services by the DBHDS; and
e. Persons providing case management services
must have knowledge of:
(1) Services,
systems, and programs available in the community including primary health care,
support services, eligibility criteria and intake processes, generic community
resources, and mental health, mental retardation, and substance abuse treatment
programs;
(2) The nature of serious
mental illness, mental retardation and/or substance abuse depending on the
population served, including clinical and developmental issues;
(3) Different types of assessments, including
functional assessments, and their uses in service planning;
(4) Treatment modalities and intervention
techniques, such as behavior management , independent living skills training,
supportive counseling, family education, crisis intervention, discharge
planning, and service coordination;
(5) The service planning process and major
components of a service plan;
(6)
The use of medications in the care or treatment of the population served;
and
(7) All applicable federal and
state laws, state regulations, and local ordinances.
f. Persons providing case management services
must have skills in:
(1) Identifying and
documenting an individual's need for resources, services, and other
supports;
(2) Using information
from assessments, evaluations, observation, and interviews to develop
individual service plans;
(3)
Identifying services and resources within the community and established service
system to meet the individual's needs; and documenting how resources, services,
and natural supports, such as family, can be utilized to achieve an
individual's personal habilitative/ rehabilitative and life goals;
and
(4) Coordinating the provision
of services by diverse public and private providers.
g. Persons providing case management services
must have abilities to:
(1) Work as team
members, maintaining effective inter- and intra-agency working
relationships;
(2) Work
independently performing position duties under general supervision ;
and
(3) Engage and sustain ongoing
relationships with individuals receiving services.
F. Providers may bill
Medicaid for mental health case management to youth at risk of serious
emotional disturbance only when the services are provided by qualified mental
health case managers.
G. The state
assures that the provision of case management services will not restrict an
individual's free choice of providers in violation of § 1902(a)(23) of the
Act .
1. Eligible recipients will have free
choice of the providers of case management services.
2. Eligible recipients will have free choice
of the providers of other medical care under the plan .
H. Payment for case management services under
the plan must not duplicate payments made to public agencies or private
entities under other program authorities for this same purpose.
I. Case management may not be billed
concurrently with intensive community treatment services, treatment foster care
case management services, or intensive in-home services for children and
adolescents.
Notes
Statutory Authority
§ 32.1-325 of the Code of Virginia.
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