D.C. Mun. Regs. tit. 29, r. 4225
Case management agencies shall ensure that case managers shall not have a client caseload exceeding forty (45) persons (inclusive of Medicaid and non-Medicaid beneficiaries).
In accordance with Section 4210, the case management agency shall be responsible for ensuring that case managers are available during regular business hours Monday through Friday, and on call during weekends and evenings in cases of emergency.
Each case manager shall take all required trainings offered by DHCF and complete mandatory training in Person-Centered Thinking, Supported Decision-Making, and Supported Community Integration, in order to promote the efficient and effective delivery of Medicaid- financed services.
Each case management agency shall develop an emergency response policy or plan to convey expectations of case managers whereby the case manager coordinates and implements services and ensures the beneficiary's safety, and wellness upon the beneficiary's notification to the case manager about the need for emergency care. This shall also include how the case managers are expected to be available and on call during weekends and evenings in cases of emergency as referenced in Subsection 4225.2.
Each case management agency shall develop an incident management reporting policy to report, investigate, and follow- up the results of the investigation conducted pursuant to DHCF's Long Term Care Administration's incident management policy, as set forth in Section 4254 (Incidents and Complaints).
In accordance with Section 4205, a case manager may coordinate the approval by DHCF or its designee for all program modification requests. These include requests to initiate, change, transfer, terminate, discharge, or suspend services.
When coordinating program modification requests, the case manager shall ensure that provider requirements including notices and steps to ensure safe discharge, suspensions, transfers or service terminations were met.
In the event that a change in service is requested, the beneficiary's case manager shall ensure that the PCSP is updated to reflect the change. Changes in service shall not be implemented until the PCSP is updated, approved by DHCF or its designee, and shared with the beneficiary and/or the authorized representative, unless a delay in the receipt of services would put the beneficiary's health and safety at risk, or if services are needed to effectuate a timely discharge from an institution.
If EPD Waiver services are needed to effectuate a timely discharge from an institution during transitional case management, the case manager shall coordinate the modifications to change and/or initiate services by DHCF or its designee by submitting a new beneficiary freedom of choice form whereby the beneficiary elects to receive HCBS services and the case manager must amend the PCSP to reflect the services within ten (10) business days of the submission of the request to DHCF or its designee to authorize services.
The case manager or case management agency shall coordinate dis-enrollments from the EPD Waiver program in accordance with the criteria set forth in Section 4205.
D.C. Mun. Regs. tit. 29, r. 4225