Haw. Code R. § 17-1738-16

Current through November, 2024

Section 17-1738-16 - Covered services

(a) Covered services means services that are reimbursable by medicaid, and are grouped under the following three categories:

(1) Case assessment;

(2) Case planning; and

(3) Ongoing monitoring and service coordination.

(b) The case assessment shall involve a face-to-face contact with the recipient and may involve family members and other interested persons as appropriate. It is a comprehensive assessment developed by the case manager which identifies the recipients' abilities, deficits, and needs, and shall include the following written documentation:

(1) Identifying information;

(2) A record of any physical, mental, or dental health assessments, and consideration of any potential for rehabilitation;

(3) A review of the recipient's performance in carrying out activities of daily living and degree of assistance required;

(4) Identification of social relationships and support including informal care givers such as family, friends, and volunteers, as well as formal service providers;

(5) If appropriate, the vocational and educational status, including prognosis for employment, rehabilitation;

(6) Legal status if appropriate, including whether there is a guardian, or any other involvement with the legal system; and

(7) Accessibility to community resources which the recipient needs or wants.

(c) Case planning activities follow the case assessment and includes the development of an individual service plan in writing which addresses the needs of the recipient.

(1) The development of the individual service plan shall be a collaborative process involving the recipient, the family or other interested persons, and the case manager.

(2) The service shall include:

(A) Problems identified during the case assessment;

(B) Priority goals to be achieved;

(C) Identification of all formal services which are to be arranged for the recipient, and the names of the service providers;

(D) Development of a support system, including a description of the recipient's informal support system;

(E) Identification of individuals who participated in the development of the service plan;

(F) Schedules of initiation and frequency of various services which are to be made available to the recipient; and

(G) Documentation of unmet needs and gaps in service.

(d) Ongoing monitoring and service coordination shall include:

(1) Establishment and maintenance of a supportive relationship with the recipient in order to assist the individual in problem-solving, and development of necessary skills to remain in the community;

(2) Face-to-face or telephone contacts with the recipient for the purpose of assessing or reassessing needs, or for planning or monitoring services;

(3) Face-to-face or telephone contacts with collaterals for the purposes of mobilizing services and support, advocating on behalf of the recipient, educating collaterals on the needs of the recipient, and coordinating services specified in the service plan;

(4) Periodic observation of service delivery to ensure that quality service is being provided and shall evaluate whether a particular service is effectively meeting the needs of the recipient; and

(5) Recordkeeping necessary for case planning, service implementation, monitoring, and coordination. This includes preparation of reports, updating service plans, making notes about case activities in the recipient's record, and preparing and responding to correspondence with the recipient and collaterals.

Haw. Code R. § 17-1738-16

[Eff 08/01/94] (Auth: HRS § 346-14; 42 C.F.R. §431.10 ) (Imp: 42 U.S.C. §1396 n )