Section R9-28-510. Case Management

A.      A program contractor shall assign to each member a case man- ager to identify, plan, coordinate, monitor, and reassess the need for and provision of long-term care services.

B.       A case manager shall:

1.        Ensure that appropriate ALTCS placement and services are provided for a member within 30 days of enrollment;

2.        Develop a service plan by:

a.         Completing a case management plan when a mem- ber is enrolled in ALTCS and authorizing services

for a member who continues to be financially and medically eligible for services;

b.        Ensuring that a member participates in the prepara- tion of the member’s case management plan;

c.         Specifying the paid and natural support services to be received by the member, including the duration, scope of services, units of service, frequency of ser- vice delivery, provider of services, and  effective time period; and

d.        Coordinating with the primary care provider in determining the necessary services for the member, including hospital and medical services;

3.        Submit a written justification to the case manager’s supervisor to include HCBS in the case management plan if the services exceed 80 percent of the institutional cost;

4.        Manage a case management plan by:

a.         Re-evaluating and revising the case management plan when the member transfers to another facility, transfers to a hospital, has a change in level of care; and

b.        Monitoring receipt of services by a member;

5.        Assist the member to maintain or progress toward the highest level of functioning;

6.        Ensure that records are transferred when the member is transferred from a facility or provider to a new facility or provider;

7.        Perform additional monitoring of a member with rehabil- itation potential and whose condition is fragile or unsta- ble, whose case management plan is marginally cost effective, or whose use of medical and hospital services is unusual;

8.        Arrange behavioral health services, if necessary. The case manager shall have initial and quarterly consultation and collaboration with a behavioral health  professional to review the treatment plan, unless the case manager meets the definition of a behavioral health professional under

A.A.C. R9-20-101.

C.      A program contractor shall submit a service plan and other information related to the case management plan upon request to the Administration.

Historical Note

Adopted effective October 1, 1988, filed September 1,

1988 (Supp. 88-3). Amended effective June 6, 1989

(Supp. 89-2). Amended effective July 13, 1992 (Supp.

92-3). Amended effective November 5, 1993 (Supp. 93-

4). Amended effective December 8, 1997 (Supp. 97-4). Amended by final rulemaking at 11 A.A.R. 4286, effec- tive December 5, 2005 (Supp. 05-4). Amended by final

rulemaking at 18 A.A.R. 3380, effective January 1, 2013

(Supp. 12-4).