Ohio Admin. Code 5160-27-10 - Substance use disorder targeted case management
(A)
Targeted case
management assists an individual within the eligible target population to gain
access to needed medical, social, educational and other services.
(1)
Targeted case
management services shall include, at a minimum, the following
activities:
(a)
Comprehensive assessment and periodic reassessment of
individual needs to determine the need for any medical, educational, social or
other services. Assessment activities include taking client history;
identifying the individual's needs and completing related documentation and
gathering information from other sources such as family members, medical
providers, social workers and educators to form a complete assessment of the
eligible individual.
(b)
Development and periodic revision of a specific care
plan that is based on the information gathered through the assessment. The care
plan must include the following requirements:
(i)
Goals and actions
to address the medical, social, educational and other services needed by the
individual; and
(ii)
A plan to ensure the active participation of the
eligible individual and or their authorized health care decision maker;
and
(iii)
A course of action to respond to the assessed needs of
the eligible individual.
(c)
Referral and
related activities to help the eligible individual obtain needed
services
(d)
Monitoring and follow-up activities or contacts that
are necessary to ensure that the care plan is implemented and adequately
addresses the eligible individual's needs. Changes in needs or status must be
reflected in the care plan. Monitoring shall be performed no less frequently
than annually. Monitoring may be performed in person or by electronic
communication.
(B)
In order to
provide targeted case management, practitioners must meet the requirements in
paragraph (A)(6) of rule
5160-27-01
of the Administrative Code. For the purposes of this rule, the following
unlicensed practitioners are excluded: qualified mental health specialists and
peer recovery supporters.
(C)
The following activities or contacts do not constitute
targeted case management and are ineligible for reimbursement as targeted case
management:
(1)
Transportation.
(2)
Waiting with an
individual for appointments at social service agencies, court hearings and
similar activities does not, in and of itself, constitute case
management.
(3)
Direct services to which the client has been referred
such as medical, educational or social services.
(4)
Internal quality
assurance activities, such as clinical supervisory activities and/or case
review/staffing sessions.
(D)
Targeted case
management services will not be separately reimbursed when a recipient is
enrolled in a substance use disorder (SUD) residential treatment
facility.
(E)
Targeted case management services require prior
authorization from the Ohio department of medicaid (ODM) designated entity when
a recipient is enrolled in an assertive community treatment (ACT) or intensive
home based treatment (IHBT) team.
Notes
Promulgated Under: 119.03
Statutory Authority: 5162.02, 5162.05, 5164.02
Rule Amplifies: 5164.02, 5164.03
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