4216 SPECIFIC PROVIDER REQUIREMENTS: CASE MANAGEMENT AND RELATED WAIVER SERVICES

4216.1 Each individual providing case management and related waiver services shall meet the following requirements:- (a) Be at least eighteen (18) years of age;

- (b) Be a United States citizen or alien who is lawfully authorized to work in the United States;

- (c) Provide proof of the supporting documents for the Immigration and Naturalizations Services Form I-9 requirements;

- (d) Meet the minimum standards for providing case management services; personal care aide services; personal emergency response system services; respite services; homemaker services; chore aide services; and environmental accessibility adaptations services.

- (e) Be able to read and write in English;

- (f) Be acceptable to the recipient;

- (g) Be free of active tuberculosis as confirmed by an annual purified protein derivative (PPD) skin test or chest x-ray;

- (h) Be free of active tuberculosis and any other communicable disease; and

- (i) Provide evidence of acceptance or declination of the Hepatitis vaccine.4216.2 Individuals conducting case management services shall meet one of the following requirements:- (a) Have a current appropriate licensure, and have a Masters degree in social work, psychology, counseling, rehabilitation, nursing, gerontology, or sociology and have at least one (1) year of experience working with the elderly or individuals with physical disabilities;

- (b) Have a current appropriate licensure and have a Bachelors degree in social work, psychology, counseling, rehabilitation, nursing, gerontology, or sociology and have two (2) years of experience working with the elderly or individuals with physical disabilities; or

- (c) Have a current license as a Registered Nurse (RN), and have an Associate degree in nursing, and at least three (3) years of experience working with the elderly and individuals with physical disabilities.4216.3 Case management service providers shall not provide medical, financial, legal, or other service or advice for which they are not qualified or licensed to perform (except for referral to qualified individuals, agencies, or programs).4216.4 Each case management service provider is responsible for conducting a comprehensive assessment of the recipient by using the assessment tool that is provided by the MAA.4216.5 Each case management service provider shall conduct a comprehensive assessment within forty-eight (48) hours of receiving the waiver referral and prior to the development of the ISP.

4216.6 Each case management service provider shall complete the written assessment and ISP within forty-eight (48) working hours of conducting the comprehensive assessment.

4216.7 Each case management service provider shall include family members, friends of the recipient, and any other appropriate individual(s) in the initial recipient assessment and in the development and implementation of the ISP, as appropriate. The recipient or authorized representative shall have access to the ISP and shall be involved in the periodic review thereof.

4216.8 A case management service provider shall submit to the MAA the following documentation for review and approval within seven (7) working days of its receipt:

(a) Documentation that the recipient is Medicaid-eligible and include the Medicaid application and supporting documents;

(b) A signed "Waiver Beneficiary Freedom of Choice Form;"

(c) Documentation of a comprehensive assessment (Recipient Health History);

(d) Bill of Rights and Responsibilities; and

(e) Completed ISP for review and approval.

4216.9 It is the responsibility of the case management service provider to ensure that all other professional disciplines as identified for resolution of identified needs are incorporated into the ISP.

4216.10 Each case management service provider shall maintain, follow, and continually update a training and supervision program to make sure the case management staff person who is responsible for the provision of case management services is fully trained and familiar with the waiver policies and procedures.

4216.11 Each provider of case management services shall ensure that case management service providers are appropriately supervised and that the case management service provided is consistent with the recipient's ISP.

SOURCE: Final Rulemaking published at 50 DCR 9025 (October 24, 2003).