104 CMR, § 29.05

Current through Register 1533, October 25, 2024

Section 29.05 - Case Management

(1) Individuals who are determined to need Case Management shall be referred to the appropriate case management office.

(2)Case Management. Case Management shall include:

(a) arranging for and completing comprehensive assessments of service needs;

(b) convening service planning meetings;

(c) developing and reviewing individual service plans;

(d) reviewing community service plans, when applicable, to ensure compatibility with clients' individual service plans;

(e) assisting clients in obtaining other available services from public or private entities as are identified in clients' individual service plans, including behavioral health and medical benefits available through commercial and publicly funded health plans and programs;

(f) coordinating services for clients, and/or monitoring the coordination of DMH and non DMH services;

(g) providing outreach, as needed;

(h) providing intensive support and advocacy, as needed;

(i) reviewing private and public health plan entitlements and options to assist the client in selecting third party benefits that best match service needs and maintain continuity of care;

(j) other services within the scope of the Medicaid service known as targeted case management.

(3)Critical Need Case Management; Transition Case Management.

(a) The Area Director or designee may authorize critical need case management for an individual during the pendency of a service authorization application, as provided in 104 CMR 29.04(1)(g), or after an individual has been authorized for DMH services, if a specific critical need is identified within the scope of Case Management Services.

(b) Critical need case management shall include active short term engagement to complete an assessment of service needs and service planning activities required for Case Management pursuant to 104 CMR 29.06 and 104 CMR 29.07 and may include other activities as provided in 104 CMR 29.05(2); provided however, the assessment of service needs, specific activities and time frames for such activities may be modified in the sole discretion of the Area Director or designee as necessary to meet the identified critical need.

(c) Transition case management shall be authorized for an individual as provided in 104 CMR 29.04(6).

(d) Transition case management shall include active engagement, assessment of service needs and service planning activities to facilitate the diversion or discharge of individuals from nursing facilities.