Cal. Code Regs. Tit. 22, § 51271 - Targeted Case Management Services Provider Qualifications
(a) A targeted case
management provider of services shall be a local governmental agency and shall:
(1) Contract with the department to provide
targeted case management services as a condition of enrollment as a targeted
case management provider in the Medi-Cal program, and
(2) Provide and certify the non-federal
match, and
(3) Have an established
fee mechanism effective January 1, 1995, specific to targeted case management
services provided, which may include a sliding fee schedule based on income and
vary by program, and
(4) Have an
established procedure for performance monitoring that assures the participating
units are complying with state and federal requirements, and
(5) Make available to the department a
performance monitoring plan, including protocols and procedures, establishing a
countywide system to assure non-duplication of services and to ensure
coordination and continuity of care among providers of targeted case management
services provided to beneficiaries who are eligible to receive case management
services from two or more programs.
(6) Have an administrative capacity to ensure
quality of services in accordance with state and federal
requirements.
(7) Have a financial
management capacity and system that provides documentation of services and
costs.
(8) Have a capacity to
document and maintain individual case records in accordance with state and
federal requirements.
(9) Have a
demonstrated ability to meet all requirements of state and federal law
governing the participation of providers in the state Medicaid program,
including but not limited to, the ability to meet federal and state
requirements for documentation, billing and audits.
(10) Have a minimum of five years of
experience in providing case management services to the target
population.
(b) In
addition to the requirements specified in subsection (a), targeted case
management service providers shall meet the following supplemental
requirements:
(1) For the purpose of providing
targeted case management services to high-risk persons identified in Section
51185(b) the
targeted case management services provider shall:
(A) Designate a public health agency
employing staff with case manager qualifications as specified in Section
51272.
(B) Have the ability to evaluate the
effectiveness, accessibility and quality of targeted case management services
on a community-wide basis.
(C) Have
established referral systems and demonstrated linkages and referral ability
with essential social and health services agencies.
(2) For the purpose of providing service to
the target population specified in Section
50262.7(a)(2) the
targeted case management services provider shall:
(A) Designate a public health agency
employing staff with case manager qualifications as specified in Section
51272.
(B) Ensure 24-hour availability of case
management services and continuity of those services.
(C) Have the capacity to communicate with
persons who have little or no proficiency in the English
language.
(3) For the
purpose of providing service to the target population specified in Section
50262.7(a)(3)(A)
the targeted case management services provider shall:
(A) Ensure 24-hour availability of case
management services and continuity of those services.
(B) Have established referral systems and
demonstrated linkages and referral ability with essential social and health
service agencies.
(4) For
the purpose of providing service to the target population specified in Section
50262.7(a)(3)(B), (C) or
(D), the targeted case management services
provider shall:
(A) Designate an agency
employing staff with case manager qualifications as specified in Section
51272.
(B) Ensure 24-hour availability of case
management services and continuity of those services.
(C) Have established referral systems and
demonstrated linkages and referral ability with essential social and health
services agencies.
(5)
For the purpose of providing service to the target population specified in
Section 50262.7(a)(3)(E)
the targeted case management services provider shall:
(A) Demonstrate programmatic and
administrative experience in providing services which prevent
institutionalization and have the ability to increase their service capability
to provide services to adults of all ages.
(B) Demonstrate they have an advisory group
which includes representatives of the target group.
(C) Have established referral systems and
demonstrated linkages and referral ability with essential social and health
services agencies.
(c) A local education agency may not enroll
as a targeted case management services provider.
(d) To qualify as a provider of targeted case
management services, local governmental agencies shall:
(1) Notify the department in writing of the
intent to claim targeted case management for a specific targeted group. Such
notice shall be received by the department no later than September 1 of each
year, and
(2) Demonstrate
participation in a time survey as scheduled by the department,
and
Notes
2. New section refiled 10-29-96 as an emergency; operative 10-29-96 (Register 96, No. 44). Submitted to OAL for printing only pursuant to Section 6, Chapter 305, Statutes of 1995. A Certificate of Compliance must be transmitted to OAL by 2-26-97 or emergency language will be repealed by operation of law on the following day.
3. Editorial correction of HISTORY 2 (Register 97, No. 15).
4. Repealed by operation of Government Code section 11346.1(g) (Register 97, No. 15).
5. New section filed 4-10-97; operative 4-10-97 pursuant to Government Code section 11343.4(d) (Register 97, No. 15).
Note: Authority cited: Sections 10725, 14105, 14124.5 and 14132.44, Welfare and Institutions Code. Reference: Section 14132.44, Welfare and Institutions Code.
2. New section refiled 10-29-96 as an emergency; operative 10-29-96 (Register 96, No. 44). Submitted to OAL for printing only pursuant to Section 6, Chapter 305, Statutes of 1995. A Certificate of Compliance must be transmitted to OAL by 2-26-97 or emergency language will be repealed by operation of law on the following day.
3. Editorial correction of History 2 (Register 97, No. 15).
4. Repealed by operation of Government Code section 11346.1(g) (Register 97, No. 15).
5. New section filed 4-10-97; operative 4-10-97 pursuant to Government Code section 11343.4(d) (Register 97, No. 15).
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