Texas Register, Volume 14, Number 56, Pages 3725-3858, August 4, 1989 Page: 3,796
3725-3858 p. ; 28 cm.View a full description of this periodical.
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management services and that meets the
following requirements:
(A) the cost is not for per-
sonal or other activity not specifically re-
lated to the provision of case management
services;
(B) the cost does not appear
on the list of specific unallowable costs and
is not unallowable under other federal,
state, or local laws or regulations. See defi-
nition of the term "unallowable cost" in this
section, and see 31. 11(e)(3) of this title
(relating to Reimbursement Methodology
for Case Management for Individuals with
Mental Retardation or Related Condition);
(C) the cost bears a signifi-
cant relationship to case management ser-
vices. The test of significance is whether
there would be an adverse impact on the
delivery of case management services if the
expenditure were eliminated.
Prospective rates-Fixed costs that
are determined for a future period of time
and that are not to be readjusted during that
period.
Reasonable cost-The amount that
does not exceed the cost which would be
incurred by a prudent business operator
seeking to contain costs.
Related condition-A severe, chronic
disability that meets all the criteria outlined
in 42 Code of Federal Regulations
435.1009.
Subaverage general intellectual
functioning-Measured intelligence on stan-
dardized psychometric instruments of two
or more standard deviations below the age
group mean for the tests used.
Unallowable cost-A cost that is not
a reasonable or necessary cost for the provi-
sion of case management services. See defi-
nitions of the terms "necessary cost" and
"reasonable cost" in this section.
313. Eligible Individuals. To be eligible
for case management services, individuals,
regardless of age, must be:
(1) mentally retarded or have re-
lated conditions;
(2) eligible for Medicaid; and
(3) require long term care in the
community.
315. Case Management Services. Case
management services are provided to assist
eligible clients, as defined in 31.3 of this
title (relating to Eligible Individuals), in
gaining access to medical, social, educa-
tional, and other appropriate services to
help these individuals reach or maintain an
optimal level of functioning in a
community-based setting. The case manage-
ment services system includes:
(1) case management intake.
Initial contact is made with the client todetermine the level of assessment needed.
At intake, the case manager will decide if
the individual is in need of crisis interven-
tion or if a comprehensive assessment is
appropriate. Intake screening must include
client identifying information and the nature
of the current presenting problem. Intake
may be done by telephone, through a face-
to-face interview, or by referral from an-
other professional;
(2) crisis intervention. Crisis in-
tervention is appropriate for eligibles whose
circumstances are a threat to either them-
selves or others and who require an imme-
diate response. These services must be
available 24 hours, seven days a week;
(3) comprehensive assessment.
(A) The written comprehen-
sive assessment is completed by the case
manager using the TDMHMR case manager
standards and procedures. At a minimum,
the written assessment must address the fol-
lowing:
(i) identifying informa-
tion;
(ii) physical health;tional status;
of functioning;
and/or support(iii) social and/or emo-
(iv) diagnosis and/or level
(v) social relationships
network;(vi) existing care being
provided through the informal support sys-
tem (including family);
(vii) activities of daily
living;
(viii) physical living envi-
ronment and/or housing and/or transporta-
tion;
(ix) analysis of source of
income and/or resources;cational status;
the client.(x) vocational and/or edu-
(xi) legal status;
(xii) unmet care needs of(B) If the comprehensive as-
sessment reveals that there is no need for
case management services, referrals may be
made that will meet the client's other needs.
(4) service plan. The written
service plan is developed to address the
specific care needs of the client. The service
plan is developed, to the extent possible,
with the client, his family, or other support
system(s). The service plan must include at
a minimum, documentation of:
(A) the persons involved in
the development of the service plan;(B) measurable goals to be
achieved via the provision of care;
(C) a description of all ser-
vices to be provided;
(D) the periodic review of
the service plan and description of unmet
needs; and
(E) schedules for the case
manager to monitor the service plan and to
perform a formal reassessment;
(5) service implementation. The
case manager arranges for the delivery of
appropriate services to the client. Through
negotiation, the case manager will act as an
advocate for the client and assist service
provider agencies in planning and program
development that will meet the needs of
persons who are mentally retarded or have a
related condition;
(6) staff consultation. The case
manager may provide consultation to other
human service and health care professionals
regarding the needs of the client. Staff con-
sultation may be provided in a residential or
community based setting, unless the consul-
tation is specifically excluded in this section
or the Medicaid state plan;
(7) monitoring.
(A) The case manager will
monitor to determine:
(i) what services have
been delivered;
(ii) whether the services
were delivered as scheduled;
(iii) whether the services
are adequate for the client's needs.
(B) Modifications to the ser-
vice plan or a change of service provider
may be required. Monitoring will be con-
ducted on a periodic basis. Each monitoring
visit will be documented in writing.
(8) reassessment. A formal reas-
sessment of the client's progress and needs
will be conducted on a periodic basis and
will be documented in writing. At the reas-
sessment, the case manager will determine
if modifications to the service plan are nec-
essary and if the level of involvement by
the case manager should be adjusted.
31.7. Service Limitations.
(a) Case management services will
not be reimbursable as a Medicaid service if
it is duplicative or if it is associated with
the proper and efficient administration of
the state plan. Case management activities
associated with the following are not reim-
bursable as an optional targeted case man-
agement service:14 TexReg 3796 August 4, 1989 Texas Register *
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Texas. Secretary of State. Texas Register, Volume 14, Number 56, Pages 3725-3858, August 4, 1989, periodical, August 4, 1989; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth216045/m1/67/: accessed May 4, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.