Ala. Admin. Code r. 560-X-45-.05

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-45-.05 - Covered Services

NFP services can be provided through the prenatal and postpartum periods (Maternal Only Phase) and up until the infant's second birthday (Maternal/Infant Phase). Case Management Activities for both phases must include:

(1) Comprehensive assessment and periodic reassessment of individual needs to determine the need for any medical, educational, social, and/or other services. Each assessment must include:

(a) assessing client history;

(b) identifying the individual's needs and completing related documentation; and

(c) gathering information from other sources such as family members, medical providers, social workers, and educators (if necessary) to form a complete assessment of the eligible individual.

(2) Development (and periodic revision) of a specific care plan that is based on the information collected through the assessment that:

(a) specifies the goals and actions to address the medical, educational, social, and/or other services needed by the individual;

(b) includes activities such as ensuring the active participation of the eligible individual and working with the individual (or the individual's authorized health care decision maker) and others to develop those goals; and

(c) identifies a course of action to respond to the assessed needs of the eligible individual.

(3) Referral and related activities (such as scheduling appointments for the individual) to help the eligible individual obtain needed services including activities that help link the individual with medical, educational, and social providers or other programs and services that are capable of providing needed services to address identified needs and achieve goals specified in the care plan.

(4) Monitoring and follow-up activities and contacts that are necessary to ensure the care plan is implemented and adequately addresses the eligible individual's needs. These activities may be with the individual, family members, service providers, or other entities or individuals and conducted as frequently as necessary. Monitoring and follow-up activities include making necessary adjustments in the care plan and service arrangements with providers. Monitoring must be conducted at least one annual monitoring, to determine whether the following conditions are met:

(a) services are being furnished in accordance with the individual's care plan;

(b) services in the care plan are adequate; and

(c) changes in the needs or status of the individual are reflected in the care plan.

Ala. Admin. Code r. 560-X-45-.05

Amended by Alabama Administrative Monthly Volume XXXIII, Issue No. 07, April 30, 2015, eff. 5/15/2015.

Repealed by Alabama Administrative Monthly Volume XXXVIII, Issue No. 03, December 31, 2019, eff. 2/14/2020.

Amended by Alabama Administrative Monthly Volume XL, Issue No. 09, June 30, 2022, eff. 8/14/2022.

Previous Rule 560-X-45-.04 was renumbered to Rule 560-X-45-.05 as per certification filed October 12, 2005; effective November 16, 2005.

Author: John Majors, Associate Director, Maternity and Family Planning

Statutory Authority: Title XIX, Social Security Act; 42 C.F.R. Section 440.169(b); and State Plan.