Section R523-7-4 - Certified Case Manager Certification(1) Definitions. (a) Targeted Case Management is a service that assists Medicaid recipients in the target group to gain access to needed medical, social, educational, and other services. The overall goal of the service is not only to help Medicaid recipients access needed services, but to ensure that services are coordinated among all agencies and providers involved.(b) Case Management services include coordinating, advocating, linking and monitoring services to help individuals access needed medical healthcare, behavioral healthcare, basic needs, housing, educational, social, and other services. Case Managers assess individual needs and develop a plan designed to help the individual obtain access to a coordinated array of services. (c) Certified Case Manager Certification means the process by which a non-licensed individual obtains certification from the Division. Case manager certification allows the Certified Case Manager to provide services for individuals with mental illness, substance use disorders, and/or individuals experiencing homelessness.(2) Case Management services can be provided by:(a) A qualified provider, as defined in the Utah Medicaid Provider Manual, found at https://medicaid.utah.gov/ Documents/manuals/pdfs/Medicaid%20Provider %20Manuals/Targeted%20Case%20Management/Serious%20Mental %20Illness/SeriousMentalIllness1-19.pdf for Targeted Case Management for individuals with Serious Mental Illness; or (b) An individual under the supervision of a qualified provider employed or contracted by the Utah Department of Human Services, (DHS) a local mental health authority, a local substance abuse authority, a DHS licensed homeless shelter, or a targeted homeless service program defined as: public or private not-for-profit organizations, faith-based organizations, state departments and agencies, units of local governments and Indian tribal governments who provide services to children, individuals, and/or families who are experiencing homeless or at risk of experiencing homeless contracted by the Department of Workforce Services (DWS).(3) Supervisors of case managers billing Medicaid for case management services must be qualified providers as defined in (2) (a).(4) Supervisors of case managers not providing Medicaid billable services must have one of the following:(a) A Bachelor's Degree in human services or a related field and two years of experience in human services;(b) An Associate's Degree in human services or a related field and three years of experience in human services; or(c) Five years of experience in human services.(5) Certified Case Manager duties include activities that assist individuals with: (a) Serious mental illness; (b) Serious emotional disturbance;(c) Substance use disorders; and(d) Services related to homelessness; (e) Accessing medical and related therapeutic services; and(f) Promoting the individual's general health and their ability to function independently and successfully in the community.(6) A Certified Case Manager must meet the following minimum standards: (a) Be at least 18 years of age;(b) Have at least a high school degree or a General Education Diploma(GED); and(c) Be employed or subcontracted by DHS, a local mental health authority or a local substance abuse authority, a DHS licensed homeless shelter, or a targeted homeless program as defined in R523-7-4(2)(b); and(d) Meet one of the following: (i) Prior to applying for the Case Management Certification, obtain 400 hours experience within the previous 10 years of application submission in human services or related fields, which may include relevant education/volunteer activities; or(ii) Be a Certified Peer Support Specialist or Family Resource Facilitator and have been actively working in the humans services field for at least 400 hours within the previous 10 years of the application submission date; or(iii) Have at least a bachelor's degree in Human Services or a related field of study;(e) Pass a Division exam which tests basic knowledge, ethics, attitudes and case management skills with a score of 70 percent or above; and(f) Have completed a Division approved 40-hour supervised case management practicum.(7) The Division Director or designee shall determine if experience and qualifications are satisfactory to exceed the required standards, and if there are any training requirements that may be waived due to prior experience and training to grant an exemption of any of the above requirements. In order to qualify for an exemption, the applicant must provide documentation of qualifications exceeding those required by this certification.(8) Applications and instructions to apply for certification to become a Certified Case Manager can be obtained from the Division. Only complete applications supported by all necessary documents shall be considered. (a) Applicants or the agency submitting the application shall respond to any Division requests for additional information regarding the application within 30 days or the Certified Case Managers certification may be denied.(b) Individuals shall be notified in writing of disposition and determination to grant or deny the application within 30 days of submission including response to Division requests for additional information of the Certified Case Manager's application. The Division shall issue a certificate verifying the certification is valid for three years, and the certificate shall be transferable across qualified employers.(c) If the application is denied the individual may file a written appeal within 30 days to the Division Director or designee.(9) Each Certified Case Manager is required to complete and document 30 training hours related to mental health, substance use disorder homelessness, trauma informed care or related topics over the 3 year certification period. Training hours must include at least 4 hours of ethics and 3 hours of suicide prevention training. (a) A Certified Case Manager shall retain training documentation. Documentation should not be sent to the Division unless requested for an audit.(b) Documents to verify training include:(i) A certificate of completion documenting continuing education validation furnished by the presenter;(ii) A letter of certificate from the sponsoring agency verifying the name of the program, presenter, and number of hours attended and participants; or(iii) An official grade transcript verifying completion of an undergraduate or graduate course(s) of study.(10) Certified Case Managers shall abide by the Provider Code of Conduct pursuant to Section R495-876, and as also found in the DHS Provider Code of Conduct Policy. (a) Each employer that becomes aware of a Certified Case Manager engaging in unprofessional or unlawful conduct, or has violated the provider code of conduct shall: (i) immediately take action to review the allegations,(ii) take steps to ensure that all individuals involved with the allegation are protected, and(iii) notify the Division within 30 days.(b) Termination of certification shall be made effective immediately if the alleged violation(s) results in one or more of the following: (i) personal financial gain through deception, or a business transaction with a client, by the Certified Case Manager,(ii) physical or emotional harm to a person that is caused by the Certified Case Manager, or(iii) a financial loss to a client, the State, or another employee that is caused by the Certified Case Manager.(c) The Division shall take the following actions when it becomes aware of a Certified Case Manager in violation of the provider code of conduct that does not result in immediate termination: (i) Within 30 days of becoming aware of the violation(s), the Division shall notify the Certified Case Manager, in writing, through a Notice of Agency Action specifying the area(s) of noncompliance. (ii) Within 30 days of receiving a notice of Agency Action, the Certified Case Manager shall submit an acceptable written plan to the Division explaining how they will achieve compliance.(iii) All plans shall demonstrate how the Certified Case Manager shall be in compliance within 30 days after receiving the Notice of Agency Action.(iv) If an acceptable plan of action is not received by the Division within 30 days of sending the Notice of Agency Action, the Certified Case Manager shall be notified that their certification has been suspended until an acceptable plan is submitted to the Division.(v) A Certified Case Manager must cease providing any and all case management services until a suspension is lifted.(d) The Division shall revoke the certification of any Certified Case Manager for the following reasons: (i) The Certified Case Manager fails to provide the Division with written evidence of compliance to a plan of action within 30 days after receiving a Notice of Agency Action that their certification has been suspended.(ii) The Certified Case Manager continues to provide case management services during the period of a suspension; or(iii) The Certified Case Manager receives more than two notices of noncompliance with the Provider Code of Conduct in a one-year period.(e) Any Certified Case Manager whose certification has been revoked may request an informal hearing with the Division Director or designee, in writing, within 10 business days of receiving notice of revocation.(f) The Division Director or designee shall review the request and determine to uphold, amend or reverse the action within 10 business days, and the Division shall inform the Certified Case Manager of the decision in writing.(g) Any Certified Case Manager with a revoked certification may not reapply for recertification for a period of 12 months.(11) If a Certified Case Manager fails to complete the requirements for training hours, their certificate will be revoked or allowed to expire, and will not be renewed unless the required training hours have been completed and submitted to the Division for approval within 30 days of expiration. (a) If any Certified Case Manager's certification is not renewed within the required time frame, they may not reapply for certification within 60 days of the expiration date.(12) If an individual fails the Division examination twice within a 30 day period of time, they must wait 30 days before taking the examination again. (13) The Division Director or designee shall determine if there are any training requirements that may be waived due to prior experience and training to grant an exception of any of the above requirements.(14) The Certified Case Manager's certification shall be posted and available upon request.Utah Admin. Code R523-7-4
Adopted by Utah State Bulletin Number 2016-2, effective 12/22/2015Amended by Utah State Bulletin Number 2019-18, effective 8/21/2019