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Waiver Case Management/Service Coordination

Page posted: 10/01/03

Page reviewed:

Page updated: 04/12/05

Legal Authority

Federally approved CAC, CADI, DD and BI Waiver plans, Minn. Stat. §256B.49, Minn. Stat. §256B.092, Minn. R. 9525.0004 to 9525.0036

Definition

Waiver case management/service coordination: Services that assist persons on a waiver to access needed waiver and State plan services, as well as needed medical, social, educational and other services, regardless of the funding source.

Covered Services

The following case management service activities are covered under the waivers:

  • • Annual reviews of services plans
  • • Assisting the person in the identification of potential providers
  • • Assisting the person to access services
  • • Coordination of services
  • • Development of a service plan
  • • Evaluation and monitoring of the services identified in the plan
  • • Informing the person or the person’s legal guardian or conservator, or parent if the person is a minor, of service options
  • Non-Covered Services

    Case management service activities cannot be duplicated with other Minnesota State plan or waiver services.

    Case Management Administrative Activities

    Case management administrative activities are not billable under any waiver. Case management administrative activities include:

  • • Intake
  • • Diagnosis
  • • Screening activity
  • • Service authorization
  • • Review of eligibility for services (including MA eligibility and disability certification)
  • • Responding to requests for conciliation conferences and appeals
  • Secondary Information

    All case management services billed to the CAC, CADI, DD and BI waivers must be based on a service actually provided to the person. Services must be planned and delivered based on individual need and may not be billed based on averages of the number of billable units provided to a person, nor across waiver recipients.

    Payments will not be made for waiver case management services by more than one provider. Payment is made to the provider as indicated on the service agreement.

    Some persons receiving case management under a waiver may also be determined to be eligible for other forms of case management. In these situations, the department recommends:

  • • A case manager/service coordinator is designated as the primary contact
  • • There is effective communication and coordination among the case managers
  • • Roles and responsibilities of each case manager are clearly defined so efforts are not duplicated
  • Persons eligible for and receiving case management under one of the waivers are not eligible for the following forms of case management:

  • • Targeted Case Management for Vulnerable Adults and Adults with Developmental Disabilities (VA/DD-TCM)
  • • Relocation Service Coordination (RSC)
  • CADI/BI Waiver Waiting List Guide

    Provider Standards and Qualifications

    Persons authorized for and receiving service under the CAC, CADI, DD and BI waivers may choose to receive case management services from qualified and approved vendors that have provider agreements with the State. Based on the standards contained in the waiver plans, only county agencies are qualified to provide or contract for case management services.

    However, choice of the person cannot be limited to the county of financial responsibility. This means the person may choose to receive case management services from a county other than the person’s county of financial responsibility. Please note this applies to case management service activities only. Case management administrative activities are not directly billable under any waiver.

    The provider of case management services must not have a financial interest in other services provide to a person, unless it is the county that provides the case management services.

    CAC/CADI/BI Waivers

    Case management/service coordination may be provided by a:

  • • Public health nurse or
  • • Registered nurse or
  • • Social worker
  • who are employed by, or contracted with, the local agency.

    Public health nurse

  • • Licensed under Minn. R. 6316.0100
  • • Licensed under Minn. Stat. §148.171, subd. 18
  • Registered nurse

    Social worker - CAC Waiver

  • • Graduate of a School of Social Work and
  • • Meet the minimum qualifications of a social worker under the Minnesota Merit System (per Minn. R. 9575) or county civil service system in Minnesota
  • Social worker - CADI/BI Waivers

  • • Graduate from an accredited four-year college with a major in social work, psychology, sociology, or a closely related field; or a graduate from an accredited four-year college with a major in any field and one year experience as a social worker in a public or private social service agency and
  • • Social Workers must meet the minimum qualifications under the Minnesota Merit System (per Minn. R. 9575)
  • DD Waiver

    A case manager/services coordinator must meet the following requirements:

  • • At least a bachelor degree in social work, special education, psychology, nursing, human services or other fields related to the education or treatment of persons with developmental disabilities or related conditions and
  • • One year of experience in the education or treatment of persons with developmental disabilities or related conditions
  • Additional Resources

    ⲯ嶂藄挧 Case management/service coordination training opportunities

    Templates

    HCBS Case Management Quality Assurance Monitoring Form (.DOC)

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