Section 480-3-004 - TARGETED CASE MANAGEMENTTargeted case management will be provided by Department staff or a designee. Regulatory references addressing participation by the services coordinator are also intended to allow participation by the services coordinator's supervisor, if necessary.
004.01WAIVER CONSENT. If the participant accepts Waiver services, the participant or legal guardian must sign the Waiver consent form. The Waiver consent form must be updated any time there is a change in the legal ability of the participant or legal guardian to consent to Waiver services. The Waiver consent form is not valid until the date the participant's eligibility for Medicaid has been determined. The participant's Waiver services may not be authorized until the participant signs the Waiver consent form and Medicaid eligibility is approved.004.02MONITORING. Monitoring of Waiver services includes: (A) Monthly contact between the participant and the services coordinator. Contact may be more frequent based on participant need. In-person visits must occur at least quarterly, and may occur more often if determined to be necessary by the services coordinator. All in-person contacts will be at a time, date, and location convenient to the participant. Each participant contact includes the following: (i) Confirmation services being provided by both formal and informal supports and services continue to meet the participant's needs based on participant interview and observation;(ii) Review of service usage and cost;(iii) Review of the participant's desired outcomes;(iv) Review the participant's satisfaction with the services provided;(v) Review of the participant's overall health status;(vi) Review of medical information; and(vii) Verification that providers comply with the requirements of service provision.(B) Revisions to the person-centered plan (PCP) as necessary to account for changes identified in (A)(i)-(vii) after each monthly contact; and(C) Notice to the Department within two working days that the participant has had a significant change in health or needs, the services coordinator will determine whether a reassessment of the participant's level of care, strengths, needs, and resources is necessary. A reassessment may be initiated based upon the services coordinator's observation of any improvement or decline in functioning during the participant contact.004.03COST EFFECTIVENESS DETERMINATION. To ensure ongoing cost effectiveness of the Waiver Program in accordance with 480 NAC 2-000, the Department will determine the estimated cost effectiveness for each participant.480 Neb. Admin. Code, ch. 3, § 004
Adopted effective 11/26/2014.Amended effective 10/3/2021