Revision 15-3; Effective March 11, 2015

 

 

6100 Monitoring Services and Follow-up Contacts

Revision 14-2; Effective September 1, 2014

 

The case manager is responsible for assessing how well services are meeting the individual's needs and enabling the individual to achieve the goals described in the individual plan of care (IPC). The case manager monitors implementation of the IPC at regular intervals by contacting the individual and the primary caregiver.

Due to the frequency of contacts in the Medically Dependent Children Program (MDCP), the case manager must emphasize to the individual the importance of:

  • following the IPC for delivery of authorized services;
  • using services monthly to maintain MDCP eligibility; and
  • contacting the case manager when needed.

MDCP contacts are required according to the following time frames:

  • three working days from the Transition Assistance Services (TAS) service authorization date to assess items and services delivered through TAS;
  • thirty days from the initial IPC effective date to assess IPC implementation and service delivery for the initial IPC;
  • thirty days from the initial supported employment or employment assistance service authorization date to assess implementation and service delivery;
  • thirty days from the initial Consumer Directed Services (CDS) service authorization date to assess Financial Management Services (FMS) and waiver service delivery authorized through the CDS option; and
  • at least every six months to assess service delivery for all waiver services authorized in the individual's IPC.

The case manager must document all follow-up contacts in the case file, using Form 2408, Individual Plan of Care (IPC) Service Review.

If the case manager identifies service delivery issues regarding the provider, the case manager follows Consumer Rights and Services (CRS) procedures in Section 5200, Service Delivery Issues Reported to DADS Staff.

Note: DADS staff must not discard the original Form 2408 or any other form or document completed during the face-to-face visit. The case manager must file the original handwritten document in the case file even if the form is typed after returning to the office.

 

6110 Monitoring Transition Assistance Services (TAS)

Revision 12-1; Effective May 1, 2012

 

The case manager must contact the individual within three working days of the nursing facility discharge date to assure all authorized TAS items and services have been received. If the individual reports items or services were not delivered, the case manager must contact the provider by telephone and follow up with written documentation to request the reason and status of the items or services that were not delivered.

Once the case manager has confirmed delivery of all authorized TAS items and services, the case manager must end the TAS Service Authorization record in the Service Authorization System using the date the case manager confirmed delivery of TAS as the end date.

 

6120 30-Day Contact

Revision 15-3; Effective March 11, 2015

 

The case manager must contact the individual by telephone or conduct a face-to-face visit within 30 days of the initial individual plan of care (IPC) effective date, or from the Financial Management Services (FMS) service authorization date, to ensure service initiation.

If services have not been initiated by the 30th day of the IPC start date, the case manager must contact the Financial Management Services Agency the next working day to determine the reason for the delay in service initiation.

If applicable, the case manager follows procedures in Section 5200, Service Delivery Issues Reported to DADS Staff, or Section 5300, Service Delivery Issues Reported by the Provider, to determine the appropriate steps for addressing the delay.

 

6130 IPC Service Monitoring

Revision 13-3; Effective August 1, 2013

 

The case manager reviews service delivery and implementation of the individual plan of care (IPC) by telephone or in person with the individual or the primary caregiver at least every six months. The case manager monitors implementation of the IPC at regular intervals by contacting the individual or the primary caregiver.

If the individual or primary caregiver does not have a telephone or contact cannot be made by telephone, a face-to-face visit is required. The case manager may have to make a face-to-face contact if:

  • the telephone contact indicates a significant change and the case manager cannot adequately assess the situation without a face-to-face visit;
  • the individual indicates dissatisfaction with services (including a minor home modification or adaptive aid) and the case manager cannot adequately assess the situation without a face-to-face visit;
  • any other circumstances exist that would require a face-to-face contact to adequately review the IPC; or
  • adequate information is not obtained during the telephone contact or the case manager has doubts that the individual’s health and safety is ensured.

The case manager must complete the first IPC service monitor within six months from the initial 30-day service review completed after the initial IPC effective date. See Section 6120, 30-Day Contact. The case manager must review the Respite and/or Flexible Family Support Services schedule with the individual or primary caregiver to determine if service schedule adjustments or changes to the IPC are needed.

The case manager is also responsible for determining if any existing situations jeopardize the individual's health and welfare. The case manager may schedule a face-to-face visit less than six months from the previous visit if health and safety or service delivery issues cannot be resolved adequately by telephone contact.

If the case manager identifies problems with waiver service delivery or the implementation of the IPC, the case manager may counsel the individual or primary caregiver regarding the IPC. If necessary, the case manager may convene a meeting following procedures in Section 5400, Convening a Meeting to Resolve Issues. The case manager must follow procedures in Section 5200, Service Delivery Issues Reported to DADS Staff, if the case manager identified service delivery or IPC implementation issues regarding the provider's performance.

The regional nurse may complete the IPC service monitoring review in place of the case manager, if needed. If this occurs, the regional nurse must complete Form 2408, Individual Plan of Care (IPC) Service Review, when completing the monitoring contact and file it in the case file. The regional nurse must coordinate with the case manager if changes to the IPC are needed.

Outbreak of Transmittable Disease in the General Population

During the time when Texas experiences an increase in serious transmittable diseases in the general population, certain precautions are necessary to ensure the health and welfare of the case manager who may come in contact with an individual reporting he has a contagious illness.

While it is important that service monitoring reviews are performed on a timely basis, there may be circumstances that could place the case manager at risk for contracting contagious illnesses.

If a case manager contacts an individual to schedule a monitoring face-to-face visit and the individual states he has a contagious illness, such as influenza, the case manager must document the contact and the reason for the delay of the face-to-face visit, including the stated illness. If possible, the case manager should schedule a future date for the visit when the individual thinks he will be better or complete the service monitoring review by telephone. If unable to schedule the visit for a future date, the case manager must contact the individual at least weekly until the service monitoring review can be completed.

Each contact must be documented in the case file on Form 2405, Narrative Notes. This documentation will be considered as an acceptable reason for delaying a service monitoring review.