N.H. Admin. Code § He-M 426.15

Current through Register No. 50, December 12, 2024

Section He-M 426.15 - Targeted Case Management Services

(a) Case management shall:

(1) Assist individuals eligible under the state plan in gaining access to needed medical, social, educational, and other services, on a one to one basis only;

(2) Be a covered CMHP service;

(3) Consist of at least one direct contact, either face-to-face or by telephone, with the individual or guardian within every 90 days;

(4) Be documented in the clinical record, including:

a. Whether the goals specified in the care plan have been achieved;

b. Whether the individual has declined services in the care plan;

c. Timelines for providing services and reassessment; and

d. The need for, and occurrences of, coordination with case managers of other programs.

(5) For each event, the documentation shall include:

a. The name of the individual;

b. The dates of case management service;

c. The name of the provider agency;

d. The nature, content, and units of case management service received, including, for units:

1. The start time and duration of each event; or

2. The start and stop time for each event; and

e. The signature of the person who provided the service.

(6) Be billed only by the agency that is the primary service provider for individuals who receive services from both the behavioral health and developmental services systems.

(b) The primary service provider shall be:

(1) The agency that provides the greater dollar value of services to the individual; or

(2) The agency chosen by the consumer to provide case management subject to the following:

a. Persons who are conditionally discharged from a designated receiving facility in accordance with He-M 609 shall be considered eligible for a case manager from the behavioral health system in addition to a case manager from the developmental services system in cases where the developmental services system is the primary service provider;

b. Pursuant to He-M 426.24, providers may, with the consent of the consumer, request a waiver from He-M 426.16(a) (6) to enable consumers to receive case management by both systems; and

c. The commissioner shall grant a waiver if a review of the person's clinical condition establishes that the person has symptoms that are acute or severe and that require multiple services from the secondary service provider.

(c) Case management services shall be limited to the following:

(1) Assessment and periodic reassessment of an eligible individual to determine service needs, including the following activities:

a. Taking the individual's history;

b. 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;

c. Assessing the individual's strengths; and

d. Determining the individual's preferences;

(2) The assessment shall determine the need for the following services:

a. Medical services including, but not limited to, primary care, dental care, home health care, and assistance with activities of daily living (ADL);

b. Educational services including, but not limited to, obtaining high school or advanced degrees, skill-building classes, parenting education, and other support groups;

c. Social services including, but not limited to, employment, housing, and transportation; and

d. Other services, including but not limited to, opportunities for personal development, maintenance and support of social and familial relationships and the pursuit of hobbies and interests such as spiritual development;

(3) Development and periodic revision of a specific and comprehensive care plan based on the information collected through an assessment or reassessment that specifies the goals and actions to address the medical, social, educational, and other services needed by the eligible individual. An individual may decline to receive services in the care plan;

(4) Referral and related activities to help an individual obtain needed services, such as scheduling appointments, but not including transportation, escort, and childcare services; and

(5) Monitoring and follow-up activities, including activities and contacts that are necessary to ensure that the care plan is effectively implemented and adequately addresses the needs of the eligible individual. Monitoring shall occur no less frequently than annually.

(d) An individual shall be eligible to receive case management services when:

(1) Services are delivered in accordance with an ISP; and

(2) The individual is:

a. A severely mentally disabled person who is eligible to receive department-funded services pursuant to He-M 401; or

b. A family member of a person who is eligible for long-term care as defined in He-M 401 and is under age 21.

(e) Case management services for an individual who has been admitted to a hospital or nursing facility shall include:

(1) Providing ongoing case management services on behalf of the individual in order to ensure that services and supports are established and maintained within the community and within the community mental health system;

(2) Establishing and maintaining contact with community agencies and individuals to develop community resources, to foster access to services other than those offered through the state mental health system, and to encourage community support to the individual when he or she returns to the community;

(3) Arranging, in collaboration with the hospital or nursing facility, community supports appropriate to the individual's need;

(4) Participating in the service planning process, from initial treatment planning through discharge planning, and supporting the participation of the individual, the family, and the guardian in the treatment planning process and, with the individual's or guardian's consent, involving significant others;

(5) Providing information necessary for individual service planning, with the consent of the individual, pursuant to He-M 408;

(6) Participating in making discharge plans and in securing access to available community resources of choice in order to foster a smooth transition to the community; and

(7) After an individual involuntary commitment and conditional discharge pursuant to He-M 609, advising the administrators of the CMHP or provider and the hospital concerning the individual's progress with, and suggesting revisions in, the discharge conditions.

(f) Transitional case management shall:

(1) Be provided to individuals, under the age of 22 and over the age of 64, who are transitioning from a hospital or nursing facility to the community;

(2) Be a covered service during the last 180 consecutive days of a medicaid eligible person's institutional stay if provided for the purpose of community transition; and

(3) Be billed if the following conditions are met:

a. The individual has been discharged from the hospital or nursing facility;

b. The individual is enrolled with the community case management provider; and

c. The individual is receiving medically necessary services in a community setting.

(g) Case managers shall not exercise the state agency's authority to authorize or deny the provision of other services under the state plan.

(h) All staff providing case management services shall be supervised in accordance with the requirements contained in He-M 426.13(a) relative to supervision of staff providing functional support services.

(i) Each staff person providing case management services shall meet the requirements contained in He-M 426.13(b) and (d) relative to requirements for staff providing functional support services.

N.H. Admin. Code § He-M 426.15

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5703, eff 9-17-93; ss by #7088, eff 8-31-99; ss and moved by #8867, eff 4-13-07; ss by #9285, eff 9-30-08 (from He-M 426.14 )

Amended by Volume XXXVI Number 41, Filed October 13, 2016, Proposed by #11182, Effective 9/29/2016, Expires 3/28/2017.

Amended by Volume XXXVII Number 15, Filed April 13, 2017, Proposed by #12154, Effective 3/28/2017, Expires 3/28/2027.