Sec 36-2999.04. Case management; definition

A. In addition to services prescribed in section 36-2939, the comprehensive care for the elderly organization shall provide case management to coordinate services and promote access to all necessary medical, social and other services. Case management services include the following:

1. An in-depth assessment to determine the level of case management needed and services to be accessed.

2. An individual case management service plan outlining needed services and access plans.

3. Service plan implementation to include counseling to encourage the comprehensive care for the elderly participant's cooperation, service authorization, referral for services and case coordination.

4. A review of the service plan to be conducted on an as-needed basis, at a minimum of at least once each three month period of coverage.

B. A comprehensive care for the elderly organization shall provide payment or reimbursement only for services provided pursuant to this article under referral from its interdisciplinary team that conducts case management unless it is an emergency service.

C. For the purposes of this section, "case management" means a service that will direct participants to the most appropriate amount, duration and type of services and continually monitor and reassess a participant's need for services provided pursuant to this article.