OAC 5101:3-31-05 Case management.

 

      (A) The PAA shall be responsible for the provision of case management activities for passport consumers. There are three levels of case management involvement: consumer managed, supportive and intensive. The case manager, in collaboration with the consumer and/or caregiver, assigns the level of case management based upon the consumer's and/or caregiver's willingness and ability to participate in directing their care. In making this determination, the case manager shall use their professional judgement, and take into consideration the consumer's and/or caregiver's preferences and the assessment data. The case manager shall educate the consumer and/or caregiver regarding their role and responsibilities in their assigned level of case management. Consumers may be moved among case management levels as their condition or circumstances change. The case manager shall use the following guidelines to assign the case management level:

 

      (1) The consumer managed level shall be assigned to consumers who are willing and able to manage, organize and direct their care. Consumers and/or caregivers assigned to this level are reliable and are capable of negotiating with providers regarding the scheduling of services, directing the service tasks to be performed, and informing the case manager of changes in their needs or circumstances, as appropriate. The case manager shall be available upon the consumers' and/or their caregivers' request to assist.

 

      (2) The supportive level shall be assigned to consumers and/or their caregivers who lack the ability or willingness to completely manage their care. Consumers and/or their caregivers assigned to this level need assistance from the case manager in facilitating and coordinating services.

 

      (3) The intensive level shall be assigned to consumers whose social and/or health situations are unstable and/or the consumer's caregivers are unwilling or not capable of providing care. The consumers and/or their caregivers assigned to this level are unable to obtain and/or maintain needed resources and/or services. Consumers and/or their caregivers assigned to this level require substantial assistance from the case manager to ensure that their needs are met. The case manager works directly with the providers regarding scheduling and service changes and advocates on behalf of these consumers and/or their caregivers, as needed.

 

      (B) The case manager shall provide the following functions:

 

      (1) Develop a written care plan with each consumer, in accordance with terms and conditions mutually agreed upon by the consumer and the case manager. The care plan must address the case management involvement and services and interventions to be provided. Case managers' interventions shall not take the place of other community or passport services that can meet the consumers' needs.

 

      (2) Authorize services and all service changes identified in the consumers' care plan. Services funded by available resources other than passport services shall be used first. Medicaid covered services shall support, but not supplant, services provided by other providers or caregivers.

 

      (3) Coordinate, provide and monitor the delivery of services and interventions in the care plan to ensure that the services and interventions continue to be appropriate and update the care plan as needed.

 

      (4) Make contact with each consumer based on the assigned case management level. Contact frequencies listed in paragraphs (B)(4)(a) to (B)(4)(c) of this rule below are the minimum allowable. More frequent contact shall be made based upon the consumer's situation.

 

      (a) Consumers assigned to the consumer managed level shall be contacted at least quarterly;

 

      (b) Consumers assigned to the supportive level shall be contacted at least quarterly and a face-to-face visit shall be made at least every six months;

 

      (c) Consumers assigned to the intensive level shall be contacted at least monthly and a face-to-face visit shall be made at least every other month.

 

      (5) Assist the consumer in accessing other medical, educational and social services as appropriate.

 

      (6) Advocate, as needed, on behalf of the consumer and/or the caregiver.

 

      (7) At least annually, redetermine the consumer's passport eligibility using the criteria set forth in rule 5101:3-1-03 of the Administrative Code and reassess the consumer's case management level. The redetermination shall be conducted with the consumer and/or caregivers during a face-to-face visit.

 

      (8) Notify and collaborate with providers regarding service delivery problems and changes in the consumer's circumstances that affect service delivery, the case management level, the care plan, or any other known care and treatment plans in effect.

 

      (9) Complete provider feedback logs in accordance with rule 5101-3-31-14 of the Administrative Code.

 

      (10) Maintain PAA's consumer records documentation in accordance with the PAA's policies and procedures.

 

      (11) Disenroll consumers from passport when appropriate and provide discharge planning, as needed.

 

      (C) The case manager shall be a registered nurse or licensed social worker certified in accordance with rule 5101:3-3-14 of the Administrative Code.

 

 HISTORY: Eff 7-16-84; 12-22-86 (Emer.); 3-23-87; 7-1-90; 1-14-96; 2-22-01 

 

 Rule promulgated under: RC Chapter 119.

 

 Rule authorized by: RC 173.40, 5111.02

 

 Rule amplifies: RC 173.40, 5111.01, 5111.02

 

REPLACES FORMER RULES 5101:3-31-05 AND 5101:3-31-06

RC 119.032 review date: 21 NOV 2000, 21 NOV 2005