| (a) A CMA must ensure that:
(1) a full-time case manager is assigned to provide
case management to no more than 50 individuals at one time;
(2) a part-time case manager is assigned to provide
case management to no more than 25 individuals at one time; and
(3) for a month in which a case manager does not meet
with an individual or LAR as required by §259.79(a) of this chapter
(relating to Renewal and Revision of an IPC), the case manager has
an in-person or telephone contact with the individual or LAR or other
persons acting on behalf of the individual, such as an advocate or
family member, to provide case management.
(b) In determining the number of individuals to which
a case manager will be assigned, a CMA must consider:
(1) the intensity of an individual's needs;
(2) the frequency and duration of contacts the case
manager will need to make with the individual; and
(3) the amount of travel time involved in making such
contacts.
(c) A CMA must have:
(1) an adequate number of case managers available to
ensure the provision of case management to an individual at all times;
and
(2) a written process that ensures that case managers
are or can readily become familiar with individuals to whom they are
not ordinarily assigned but to whom they may be required to provide
case management.
(d) A CMA must ensure that a case manager participates
as a member of an individual's service planning team and uses the
person-centered planning process when developing or revising required
documentation in accordance with this chapter and the Community Living Assistance and Support Services
Provider Manual.
(e) A CMA must ensure that case management is provided
to an individual in accordance with the individual's IPC.
(f) A CMA must submit an IPC to HHSC within the time
periods required by §259.65 of this chapter (relating to Development
of an Enrollment IPC) and §259.79(g)(2)(A) and (g)(3)(A) of this
chapter to ensure that a DSA receives reimbursement for the provision
of CLASS Program services and CFC services.
(g) A CMA must follow the process for requesting authorization
to purchase dental treatment, as described in the Community Living Assistance and Support Services
Provider Manual.
(h) If an individual may need cognitive rehabilitation
therapy, a case manager must assist the individual in obtaining, in
accordance with the Medicaid State Plan, a neurobehavioral or neuropsychological
assessment and plan of care from a qualified professional as a non-CLASS
Program service.
(i) A CMA must ensure that an individual's case manager
complies with §259.205 of this chapter (relating to Residential
Agreements, Requirements for Provider-Controlled Residential Settings,
and Support Family Agency and Continued Family Agency Functions).
|
