(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
Credits
Note: Authority cited: Sections 10725, 14105, 14124.5 and 14132.44, Welfare and Institutions Code. Reference: Section 14132.44, Welfare and Institutions Code.
History
1. New section filed 7-1-96; operative 7-1-96. Submitted to OAL for printing only pursuant to Section 6, Chapter 305, Statutes of 1995 (Register 96, No. 27).
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).
This database is current through 4/26/24 Register 2024, No. 17.
