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Document 1839492
DEPARTMENT OF HEALTH AND HUMAN SERVICES
HEALTHCARE FINANCING ADMINISTRATION
1
1. TRANSMITTALNUMBER:
1
FORM APPROVED
OMB NO. 0938-0193
2. STATE:
'TRANSMITTAL AND NOTICE OF APPROVAL OF
STATE PLAN MATERIAL
FOR: HEALTH CARE FINANCING ADMINISTRATION
SECURITY ACT (MEDICAID)
-
I
1
TO.
REGIONAL ADMINISTRATOR
HEALTH FINANCING ADMINISTRATION
DEPARTMENT OF HUMAN SERVICES
5. TYPE OF PLAN MATERIAL (Check One):
NEW STATE PLAN
4. PROPOSED EFFECTIVE DATE
AMENDMENT TO BE CONSIDERED AS NEW PLAN
AMENDMENT
COMPLETE BLOCKS 6 THRU 10 IF THIS IS AN AMENDMENT (Separate Transmittal for each amendment)
6. FEDERAL STATUTEIREGULAl-ION CITATION:
DRA Section 6052
1
8. PAGE NUMBER OF THE PLAN SECTION OR ATTACHMENT:
Supplement 1 to Attachment 3.1-A, pages 1A-I thru 1A-5
7. FEDERAL BUDGET IMPACT:
a. FFY
$
b. FFY
$
9. PAGE NUMBER OF THE SUPERSEDED PLAN SECTION
UK ATTACHMENT (If Applicable)
-
Supplement to Attachment 3 I - A , pages I - A - I thru 2
10. SUBJECT OF AMENDMENT:
Targeted Case Management
11. GOVERNOR'S REVIEW (Check One):
GOVERNOR'S OFFICE REPORTED NO COMMENT
COMMENTS OF GOVERNOR'S OFFICE ENCLOSED
NO REPLY RECEIVED WITHIN 45 DAYS OF SUBMITTAL
[XI OTHER, AS SPECIFIED:
Paul Reinhart, Director
Medical Services Administration
16. RETURN TO:
-
Medical Services Administration
Program/Eligibility Policy Division - Federal Liaison Unit
Capitol Commons Center - 7'h Floor
400 South Pine
Lansing, Michigan 48933
f3. TYPED NAME:
Paul Reinhart
14. TITLE:
Director, Medical Services Administration
15. DATE SUBMITTED:
Attn: Nancy Bishop
June 30,2008
17. DATE RECEIVED:
FOR REGIONAL OFFICE USE ONLY
18 DATE APPROVED:
-
PLAN APPROVED ONE COPY ATTACHED
19. EFFECTIVE DATE OF APPROVED MATERIAL:
20. SIGNATURE OF REGIONAL OFFICIAL:
I
21. TYPE NAME:
FORM HCFA-179(07-92)
1
22. TITLE:
Instructions on Back
Supplement 1 to
Attachment 3.1 -A
Page 1A-1
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
State of MICHIGAN
Case Management Services
A. Target Group A consists of functionally limited persons with multiple needs or a high level of
vulnerability who, as shown by an assessment, require mental health case management. Such
persons must have a primary diagnosis of either mental illness or developmental disability
and a documented need for access to the continuum of mental health services offered by a
Medicaid-enrolled mental health clinic services provider. Moreover, these persons must have
a documented lack of capacity for independently accessing and sustaining involvement with
needed services.
A person in this targeted group may reside in his own home, the household of another or in a
supervised residential setting.
B. Areas of the state in which services will be provided
X
Entire State
-
Only in the following geographic areas
C. Comparability of services:
-
Services are provided in accordance with section 1902(a)(lO)(B) of the Act
X
-
Services are not comparable in amount, duration and scope.
D. Definition of services:
Case management services are services furnished to assist individuals, eligible under the State
Plan, in gaining access to needed medical, social, educational and other services. Case
Management includes the following assistance:
1. Comprehensive assessment and periodic reassessment of individual needs to determine
the need for any medical, educational, social or other services. These assessment
activities include:
a. taking client history;
b. identifying the individual's needs and completing related documentation; and
gathering information from other sources such as family members, medical
providers, social workers and educators (if necessary) to form a complete assessment
of the individual.
2. Development and periodic revision of a specific care plan that:
TN IVO.: 08-06
Supersedes
TN NO.: 92-24
Approval Date:
Effective Date: 04/01/2008
Supplement 1 to
Attachment 3.1-A
Page I A - 2
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
State of MICHIGAN
Case Management Services
a. is based on the information collected through the assessment;
b. specifies the goals and actions to address the medical, social, educational and other
services needed by the individual;
c. includes activities such as ensuring the active participation of the eligible individual
and working with the individual, or the individual's authorized health care decision
maker, and others to develop those goals; and,
d. identifies a course of action to respond to the assessed needs of the eligible
individual.
3. Referral and related activities:
Help an individual obtain needed services including activities that help link an individual
with
a. medical, social, educational providers or
b. other programs and services that are capable of providing needed services and
scheduling appointments for the individual.
4. Monitoring and follow-up activities:
Activities and contacts that are necessary to ensure the care plan is implemented and
adequately addresses the individual's needs and which may be with the individual, family
members, providers or other entities or individuals and conducted as frequently as
necessary and including at least one annual monitoring to determine whether the
following conditions are met:
a. services being furnished in accordance with the individual's care plan;
b. services in the care plan are adequate; and
c. there are changes in the needs or status of the individual and, if so, making necessary
adjustments in the care plan and service arrangements with providers.
5 . Case management may include contacts with non-eligible individuals that are directly
related to identifying the needs and supports for helping the eligible individual to access
services.
6. Case management services are coordinated with and do not duplicate activities provided
as a part of institutional services and discharge planning activities.
E. Qualifications of providers:
TN NO.: 08-06
Supersedes
TN NO.: 92-24
Approval Date:
Effective Date: 04/0112008
Supplement 1 to
Attachment 3.1 -A
Page 1A-3
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
State of MICHIGAN
Case Management Services
1. Case Management Provider Organizations must be certified by the single state agency as
meeting the following criteria:
a. demonstrate a capacity to provide all core elements of case management services
including
Comprehensive client assessment
Comprehensive carelservice plan development
c
L&;g/coordina:ion
of ser;icc;
Monitoring and follow-up of services
Reassessment of the client's status and need
b. demonstrated case management experience in coordinating and linking such
community resources as required by the target population
c. demonstrated experience with the target population
d. a sufficient number of staff to meet the case management service needs of the target
population
e. an administrative capacity to ensure quality of services in accordance with State and
federal requirements
f. a financial management capacity and system that provides documentation of services
and costs.
g. capacity to document and maintain individual case records in accordance with State
and federal requirements.
Providers of mental health case management services to target group A must meet the
qualifications for Medicaid enrollment as mental health clinic services providers.
2. A mental health case manager must:
a. be either a Qualified Mental Retardation Professional (QMRP) as defined at 42 CFR
442.50 or a Qualified Mental Health Professional (QMHP) as defined in Michigan's
Medicaid State Plan provisions for mental health clinic services providers, or
b. at a minimum, possess a bachelor's degree in a human services field and function
under the supervision of a QMRP or a QMHP.
F. Freedom of choice:
The State assures that the provision of case management services will not restrict an
individual's freedom of choice of providers in violation of section 1902(a)(23) of the Act.
1. Eligible recipients will have free choice of the providers of case management services
within the specified geographic area identified in this plan.
TI1 NO.: 08-06
Supersedes
TN NO.: 92-24
Approval Date:
Effective Date: 0410 112008
Supplement 1 to
Attachment 3.1-A
Page 1A-4
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
State of MICHIGAN
Case Management Services
2. Eligible recipients will have free choice of the providers of other medical care under the
plan.
G. Access to Services:
The State assures that case management services will not be used to restrict an individual's
access to other services under the plan.
The State assures that individuals will not be compelled to receive case management services,
condition receipt of case management services on the receipt of other Medicaid services, or
condition receipt of other Medicaid services on receipt of case management services.
The State assures that individuals will receive comprehensive, case management services on a
one-to-one basis, through one case manager.
The State assures that providers of case management services do not exercise the agency's
authority to authorize or deny the provision of other services under the plan.
The State assures that the amount, duration and scope of the case management activities
would be documented in an individual's plan of care which includes case management
activities prior to and post-discharge, to facilitate a successful transition to the community.
The State assures that case management is only provided by and reimbursed to community
case management providers.
The State assures that Federal Financial Participation is only available to community
providers and will not be claimed on behalf of an individual until discharge from the medical
institution and enrollment in community services.
H. Case Records:
Providers maintain case records that document for all individuals receiving case management
the following: the name of the individual' dates of the case management services; the name
of the provider agency (if relevant) and the person providing the case management service;
the nature, content, units of the case management services received and whether goals
specified in the care plan have been achieved; whether the individual has declined services in
the care plan; the need for, and occurrences of. coordination with other case managers; the
timeline for obtaining needed services; and, a timeline for reevaluation of the plan.
TIV NO.: 08-06
Supersedes
TN NO.: 92-24
Approval Date:
Effective Date: 04/01/2008
Supplement 1 to
Attachment 3.1-A
Page 1A-5
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
State of MICHIGAN
Case Management Services
J. Limitations:
Case Management does not include the following:
1. case management activities that are an integral component of another covered Medicaid
service;
2. direct delivery of an underlying medical, educational, social or other service to which an
e!igih!p individnaj has heen ypfp~pd;
3. activities integral to the administration of foster care programs;
4. activities for which an individual may be eligible, that are integral to the administration
of another non-medical program, except for case management that is included in an
individualized education program or individualized family service plan consistent with
section 1903( c) of the Social Security Act.
Note: This amendment shall be construed consistently with any subsequent modification to the
rules by CMS and shall not be applied if the cited regulations are not in force and effect due to
agency, congressional or judicial action.
TN NO.: 08-06
Supersedes
TN NO.: 92-24
Approval Date:
Effective Date: 0410112008
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