Assistive Care Services and Assisted Living for the Elderly Waiver

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Assistive Care Services and Assisted Living for the Elderly Wavier Services Coverage and Limitations Handbook Case Management Requirements Description Every ALE waiver recipient must have a case manager who is employed by a waiver enrolled case management agency. Case management includes identifying, organizing, coordinating, and monitoring services needed by a recipient. The case manager assists waiver recipients in gaining access to waiver services as well as other services, regardless of the funding source. Note: See Chapter 4, Case Manager Responsibilities for more information regarding the responsibilities of case managers. Components Case management must include the following documented activities: • Comprehensive needs assessment and identification of appropriate service needs; • Development of plans of care and authorization of services and service components; • Referral to available resources; • Coordination of hospice and waiver services when the ALE consumer elects hospice care; • Coordination of Medicare services with ALE waiver services; • Monitoring of services rendered; • Reassessment of recipient needs; and • Review of fair hearing rights. July 2001 5-4
Assistive Care Services and Assisted Living for the Elderly Wavier Services Coverage and Limitations Handbook Case Management Documentation Case Records A case record must be kept by the case manager for every recipient receiving ALE waiver services. The purpose of keeping this record is to assure that information regarding the recipient’s condition and service provision is contained and available for review at a single location. It is the basis of the recipient’s plan of care and the basis for quality assurance monitoring. The case manager is responsible for developing and maintaining the case record. The case manager must record all case management activities in the case narrative including: • Copies of all eligibility documents; • Assessments; • Plans of care, including accurate cost projections; • Case narratives; and • Affirmation of receipt of fair hearing rights. Case records are maintained by the case management agency at a central location. Note: See Chapter 2 of the Medicaid Provider Reimbursement Handbook, Non-Institutional 081, for additional information about documentation requirements. Case Narrative Requirements All case management activities must be recorded in the case narrative. • The narrative must be clear and comprehensive, reflecting what the case manager has done to meet the needs identified in the plan of care. • There should be documentation of any information that the case manager has learned about the activities of others on behalf of the recipient. • The case narrative should also contain a record of the case manager’s observations of the recipient’s status and must be sufficient to justify payment. July 2001 5-5
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Assistive Care Services and Assisted Living for the Elderly Waiver

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