10 Colo. Code Regs. § 2505-10-8.761

Current through Register Vol. 47, No. 9, May 10, 2024

Section 10 CCR 2505-10-8.761 - TARGETED CASE MANAGEMENT (TCM) SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITITES

.14 Targeted Case Management services for Persons with Developmental Disabilities consists of facilitating enrollment; locating, coordinating, and monitoring needed developmental disabilities services; and coordinating with other non-developmental disabilities funded services, such as medical, social, educational, and other services to ensure non-duplication of services and monitor the effective and efficient provision of services across multiple funding sources. Targeted case management services includes the following activities:

a. Comprehensive assessment and periodic reassessment of individual needs to determine the need for any medical, educational, social or other services and completed annually or when the Client experiences significant change in need or in level of support. These assessment activities include:

1. Taking Client history; and

2. Identifying the Client's needs, completing related documentation, and gathering information from other sources such as family members, medical providers, social workers, and educators as necessary, to form a complete assessment of the Client.

b. Development and periodic revision of a specific care plan that:

1. Is based on the information collected through the assessment;

2. Specifies the goals and actions to address the medical, social, educational, and other services needed by the Client;

3. Includes activities such as ensuring the active participation of the Client, and working with the Client (or the Client representative as defined in Section 8.500.1) and others to develop those goals; and

4. Identifies a course of action to respond to the assessed needs of the Client.

c. Referral and related activities to help a Client obtain needed services including activities that help link a Client with:

1. Medical, social, educational providers; or

2. Other programs and services including making referrals to providers for needed services and scheduling appointments, as needed.

d. Monitoring and follow-up includes activities that are necessary to ensure the care plan is implemented and adequately addresses the Client's needs. Monitoring and follow up actions shall:

1. Be performed when necessary to address health and safety and services in the care plan;

2. Include activities to ensure:

A. Services are being furnished in accordance with the Client's care plan;

B. Services in the care plan are adequate; and

C. Necessary adjustments in the care plan and service arrangements with providers are made if the needs of the Client have changed;

3. Include direct contact and observation with the Client in a place where services are delivered to a Client in accordance with the following frequency:

A. Face-to-face monitoring shall be completed for a Client enrolled in HCBS-DD at least once per quarter;

B. Face-to-face monitoring shall be completed for a Client enrolled in HCBS-SLS at least once per quarter;

C. Face-to-face monitoring shall be completed for a Client in HCBS-CES at least once per quarter; and

D. Face-to-face monitoring shall be completed at least once every six months for children in Early Intervention Services.

E. Upon Department approval, contact may be completed by the case manager at an alternate location, via the telephone or using virtual technology methods. Such approval may be granted for situations in which face-to-face meetings would pose a documented safety risk to the case manager or client (e.g. natural disaster, pandemic, etc.).

.15 All case documentation must be entered into the Department's IMS within five (5) business days from the date of activity.

8.761.2DETERMINATION OF CLIENT ELIGIBLITY

.21 To receive targeted case management services individuals must meet the following criteria:

a. Be determined eligible for Medicaid by the County Department of Social/Human Services in the county in which the person resides;

b. Be determined by the designated Community Centered Board to have a developmental disability or developmental delay; and

c. Be actively enrolled in one of the following programs:

1. Home and Community Based Services for Persons with Developmental Disabilities waiver (HCBS-DD);

2. Home and Community Based Services - Supported Living Services waiver (HCBS-SLS);

3. Home and Community Based Services- Children's Habilitation Residential Program (HCBS-CHRP)

3. Home and Community Based Services - Children's Extensive Support waiver (HCBS-CES); or

4. Early Intervention Services (EI).

.22 The specific programs listed in Section 8.761.21.c.1 through 4 are the only programs which are eligible for targeted case management services.

8.761.3PROVIDER ELIGIBILITY

.31 Only certified Early Intervention Services may be reimbursed for targeted case management services for persons enrolled in Early Intervention Services pursuant to 12 CCR 2509-10, Section 7.913.

.32 Only case management agencies certified by the Department pursuant to Sections 8.519 through 8.519.23 may provide case management for persons enrolled in the Home and Community Based Services outlined in Sections 8.503 Home and Community Based Services for Children's Extensive Support (HCBS-CES) Waiver, 8.508 Home and Community Based Services for Children's Residential Habilitation Program (HCBS-CRHP), 8.500 Home and Community Based Services for the Developmentally Disabled (HCBS-DD) Waiver, and 8.500.90 Home and Community Based Services for Supported Living Services (HCBS-SLS) Waiver et seq.

8.761.4REIMBURSEMENT

.41 Claims are reimbursable only when supported by the following documentation:

a. The name of the Client;

b. The date of the activity;

c. The nature of the activity including whether it is direct or indirect contact with the Client;

d. The content of the activity including the relevant observations, assessments, findings;

e. Outcomes achieved, and as appropriate, follow up action;

f. For EI services, the total number of units associated with the activity; and

g. For HCBS waiver programs, documentation required under Sections 8.519 and 8.760.

.42 TCM providers shall record what documentation exists in the log notes and enter it into the state data system as required by the Department.

.43 Claims related to EI for travel time to and from a TCM activity are reimbursable at the same unit rate as TCM services. The time claimed for travel shall be documented separately from the time claimed for the TCM activity.

.44 Reimbursement rates shall be published prior to their effective date in accordance with Federal requirements at 42 C.F.R. § 447.205 and shall be based upon a market-based. El shall continue to utilize the rate with a unit of service equal to fifteen (15) minutes according to the State's approved fee schedule. EI TCM, which is limited to 240 units per Client per state fiscal year.

.45 TCM services may not be claimed prior to the first day of enrollment into an eligible program nor prior to the actual date of eligibility for Medicaid benefits.

.46 TCM for HCBS-DD, HCBS-CES, HCBS-CHRP and HCBS-SLS are to be reimbursed based on the Departments TCM Fee Schedule.

8.761.5EXCLUSIONS

.51 Case management services provided to any individuals enrolled in the following programs are not billable as Targeted Case Management services for persons with developmental disabilities as specified in Section 8.760:

a. Persons enrolled in a Home and Community Based Services waiver not included as an eligible HCBS service as described in Section 8.761.21.c.

b. Persons residing in a Class I nursing facility.

c. Persons residing in an Intermediate Care Facility for the Intellectually Disabled (ICF-ID).

10 CCR 2505-10-8.761