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JohnPainter wrote:An excellent paper very worth reading, Morse is very correct that there are a number of case management models. Also worth recognizing are recent clarifications in Title XIX of the Social Security Act (currently under review by Congress) which define case management covered by Medicaid as services which; "assist individuals eligible under the State plan in gaining access to medical, social, educational, and other services" and include the following;
• 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. These activities are defined to include the following:
- Taking client history.
- Identifying the needs of the individual, and completing related documentation.
- 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.
• Development of a specific care plan based on the information collected through the assessment described above. The care plan specifies the goals of providing case management to the eligible individual 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
CMS-2237-IFC 13
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.
• Referral and related activities to help an individual obtain needed services, including activities that help link the eligible individual 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.
• Monitoring and follow-up activities, including activities and contacts that are necessary to ensure that the care plan is effectively implemented and adequately addresses the needs of the eligible individual. Monitoring and follow-up activities may be with the individual, family members, providers, or other entities. These activities may be conducted as frequently as necessary to help determine such matters as:
- Whether services are being furnished in accordance with the individual's care plan.
- Whether the services in the care plan are adequate to meet the needs of the individual.
CMS-2237-IFC 14
- Whether there are changes in the needs or status of the individual.
If there are changes in the needs or status of the individual, monitoring and follow-up activities include making necessary adjustments in the care plan and service arrangements with providers.
Section 6052 of the DRA also clarifies that the term "case management" does not include the "direct delivery of an underlying medical, educational, social, or other service to which an eligible individual has been referred" by adding clause section 1915(g)(2)(A)(iii) of the Act.
The paper offers some helpful information on practice which may help to improve supports to homeless individuals, when taken with existing public policy are an important resource.
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An excellent paper very worth reading, Morse is very correct that there are a number of case management models. Also worth recognizing are recent clarifications in Title XIX of the Social Security Act (currently under review by Congress) which define case management covered by Medicaid as services which; "assist individuals eligible under the State plan in gaining access to medical, social, educational, and other services" and include the following;
• 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. These activities are defined to include the following:
- Taking client history.
- Identifying the needs of the individual, and completing related documentation.
- 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.
• Development of a specific care plan based on the information collected through the assessment described above. The care plan specifies the goals of providing case management to the eligible individual 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
CMS-2237-IFC 13
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.
• Referral and related activities to help an individual obtain needed services, including activities that help link the eligible individual 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.
• Monitoring and follow-up activities, including activities and contacts that are necessary to ensure that the care plan is effectively implemented and adequately addresses the needs of the eligible individual. Monitoring and follow-up activities may be with the individual, family members, providers, or other entities. These activities may be conducted as frequently as necessary to help determine such matters as:
- Whether services are being furnished in accordance with the individual's care plan.
- Whether the services in the care plan are adequate to meet the needs of the individual.
CMS-2237-IFC 14
- Whether there are changes in the needs or status of the individual.
If there are changes in the needs or status of the individual, monitoring and follow-up activities include making necessary adjustments in the care plan and service arrangements with providers.
Section 6052 of the DRA also clarifies that the term "case management" does not include the "direct delivery of an underlying medical, educational, social, or other service to which an eligible individual has been referred" by adding clause section 1915(g)(2)(A)(iii) of the Act.
The paper offers some helpful information on practice which may help to improve supports to homeless individuals, when taken with existing public policy are an important resource.
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