Minimum case management standards manual



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MINIMUM CASE MANAGEMENT STANDARDS MANUAL
This document contains information on forms, policies and procedures for the development and provision of case management services in accordance with IDAPA 16.07.20.
case management objectives

The objectives of Case Management are to:



  • Keep the client engaged in treatment;

  • Improve client outcomes;

  • Facilitate access to needed services;

  • And, maintain the least restrictive level of care required for successful client outcomes.


case management values

The underlying values and principles listed here provide the foundation for empathic, empowering, and recovery-focused case management services:



  • The client's self-determination is maximized to the fullest extent possible.

  • The Client and the family unit are included in the process of developing outcomes.

  • Case management services are individualized and client driven.

  • Client choice is assured through offering an array of services from which the client may make choices.

  • Case management services are accessible to the client, family, guardian, and others associated with the client. Contacts with clients receiving case management services must take place in settings (clinic, home, or institution) and at times most convenient to them.

  • Case management services are community-based and address the client’s needs holistically.

  • Case management services are culturally appropriate.

  • Case management services are provided in an efficient and effective manner with accountability for client outcomes.


definition of case management

The administration and evaluation of an array of services that may include assessment of client and client family needs, service planning, linkage to other services, client advocacy, monitoring service provision, and coordination of services. Case Management services provided through the Substance Use Disorders program must not duplicate services currently provided under any other-state-funded program, such as Medicaid.


Case Management is a collaborative process that assesses, plans, links, coordinates, monitors, and advocates for options and services requires to meet the client’s health and human services needs. There are three levels of Case Management recognized within IDAPA 16.07.20

Levels

cm Qualifications

Service Type

client eligibility

contact

Clinical Case Management

Master’s Level Licensed Qualified Substance Use Disorders Professional (QSUDP) per IDAPA 16.07.20 (section 455:03)

  • QSUDP trainees may not provide Clinical Case Management services

Treatment

Client must meet the following criteria per IDAPA 16.07.20 (section 455:02):


  1. Meet ASAM criteria for a substance use disorder and be unstable in two or more of ASAM dimensions 1, 2, 5 or 6;




  1. Have a diagnosis of serious mental illness SMI as defined by the DSM-IV-TR




Determined by Clinical Case Manager based on assessed need.

Intensive Case Management

Qualified Substance Use Disorders Professional (QSUDP), an ISAS or Trainee, per IDAPA 16.07.20 (section 745:04)

  • ISAS or Trainees must have intensive clinical supervision t least one (1) hour per month and a Learning Plan.

-or-
Bachelor’s degree in a human services field from a nationally accredited university or college; and


One thousand (1,040) hours of supervised experience working with the substance use disorders population; and
Case Management Training Certificate issued by the Department within 6 (six) months of hire

Recovery Support Service

Based on assessed need



At least every thirty (30) days. Must have additional contact with the client, guardian, or provider who can verify the client’s well-being and provision of services. The frequency, mode of contact and person being contacted must be identified in the plan and meet needs of client.

Basic Case Management

Qualified Substance Use Disorders Professional (QSUDP), an ISAS or Trainee, per IDAPA 16.07.20 (section 745:04)

  • ISAS or Trainees must have intensive clinical supervision at least one (1) hour per month and a Learning Plan.

-or-
Bachelor’s degree in a human services field from a nationally accredited university or college; and


One thousand (1,040) hours of supervised experience working with the substance use disorders population; and
Case Management Training Certificate issued by the Department within 6 (six) months of hire

Recovery Support Service

Based on assessed need

Face-to-Face contact with the client at least every month.


case managemement trainee

Individuals meeting the following criteria may be classified as trainees and may provide case management services:

    • Meets Case Manager qualifications but lacking Case Management training

      1. Must attend Case Management training within 6 (six) months of designation as a Case Management Trainee

    • Bachelors Degree in a human services field but lacking experience/Case Management training

      1. Must receive one thousand forty (1,040) hours of supervised experience working with the substance use disorders population

      2. Must be under direct intensive clinical supervision and have a learning plan. *Learning plan should address the following Case Management Components:

  1. Assessment

  2. Planning

  3. Monitoring

  4. Coordinating

  5. Linking

  6. Advocating

      1. Must attend Case Management training within 6 (six) months of designation as a Case Management Trainee

    • Idaho Student of Addiction Studies (ISAS)

      1. Must maintain current ISAS certification in accordance with the Idaho Board of Alcohol/Drug Counselor’s Certification.

      2. Must be under direct intensive clinical supervision and have a learning plan. *Case Management activities may be incorporated into the learning plan developed for treatment competency.

      3. Must attend Case Management training within 6 (six) months of designation as a Case Management Trainee


supervision of case managemement

All Case managers must have at least one (1) hour of documented supervision per month.


Case management supervision includes planning, directing, monitoring and evaluating the work of a case manager by an individual who meets the qualifications of a supervisor for case management. Per IDAPA 16.07.20 (section 745:07) case management supervisors must:

-or-



  • Have a Master’s degree in a human services field and;




  • One (1) year treatment experience with at least one thousand (1,040) hours of supervised experience working with the substance use disorders population.

A Clinical Supervisor of a treatment facility may fulfill this role and may incorporate case management supervision into clinical supervision of treatment activities.


Case Management Training

Case Management trainings are conducted by BPA. Attendees must submit the required documentation to BPA prior to attending the CM training. Once a training is completed, BPA will send the training’s sign in sheet and required documentation to the Department for review and determination of whether or not an attendee meets Case Management qualifications. Important—Determination of Case Manger status is done by the Department after the training. Attendance at the training does not guarantee approval as a Case Manager.


case management certificate

Case managers must have a case management certificate issued by the Department after training is completed. Training must be completed within six (6) months of hire.


documentation of case management

Below are the IDAPA requirements outlining the necessary elements of case management forms, including supervision. Case management providers may utilize forms that are developed within their agency as long as they document the required elements from IDAPA 16.07.20. Unless notified otherwise, all agency-generated forms that contain the information listed below will be deemed Department-approved. If desired, DHW generated forms are available on the SUD website at:



http://www.healthandwelfare.idaho.gov/Medical/SubstanceUseDisorders/FindTreatment/RecoverySupportServices/tabid/381/Default.aspx
Case Management Assessments must be included in case management services. DHW has not generated a standard CM assessment form and providers may utilize assessment tools developed within their agency. Provider generated assessment tools should include assessment of the medical, psychosocial, legal, educational, and financial needs of the client.
Comprehensive service plans must be developed within 30 days of first CM appointment and be updated every 90 days. These forms must include the following:

  1. time and date of service.

  2. service needs identified in the current assessment (GAIN).

  3. Assessment of the client and client family strengths and needs.

  4. documentation that the plan was, to the maximum extent possible, developed collaboratively with the client, family members, and other support and service systems.


Case management progress notes must include the following:

  1. time and date of service.

  2. documentation of linkage to other services, client advocacy, and monitoring service provisions.

  3. Basic Case Management: documentation that face to face client contact occurred at least once per month (and as needed).

  4. Intensive Case Management: documentation that face to face client contact occurred at least once per month (and as needed). Documentation that additional contacts were made to verify the client’s well being and whether services are being provided according to the written plan.


Supervision forms must document one hour of supervision per month and include the following:

  1. time and date of supervision

  2. topics discussed

  3. whether the supervision was to a group or individual

  4. signatures and credentials of both the supervisor and individual receiving supervision

Please note that case management providers do not have to have a separate client CM file, but may if desired. However, if CM notes are put in a client’s treatment file, a separate CM section is needed. CM notes should not be mixed with treatment notes.



individual case manager case loads

The total caseload of a case manager must assure quality service delivery and client satisfaction. For those clinical case managers who have treatment or other recovery support service caseloads, or both, the total caseload must not exceed thirty (30) clients at any given time.


provider reimbursement

Reimbursable services: The following services may be billed under case management:

  • Face-to-face contact between the case manager and the client, client’s family members, legal representative, primary caregivers, service providers, or other individuals directly involved with the client’s recovery;

  • Telephone or e-mail contact between the case manager and the client, client’s family members, legal representative, primary caregivers, service providers, or other individuals directly involved with the client’s recovery;

  • Paperwork that is associated with obtaining certain needed services such as food stamps, energy assistance, emergency housing, or legal services when the client, client’s family members, legal representative, primary caregivers, service providers, or other individuals directly involved with the client’s recovery is/are present.


Non-Reimbursable services: The following services cannot be billed

  • Missed appointments

  • Attempted contact

  • Travel to provide services

  • Leaving a message

  • Transporting clients

  • Documenting services

  • Group case management

  • Mental Health services provided by clinical CM


Other Limitations on Reimbursement:

  • Clinical case mangers will not be reimbursed for more than one (1) contact during a single fifteen (15) minute time period.

  • Medicaid-Funded Case Management—case management services to be reimbursed through Medicaid must be provided by a QSUDP.




CM MANUAL OCT. 2011




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