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Part 99      CASE MANAGEMENT SERVICES FOR UNDER AGE 18 IN EMERGENCY, TEMPORARY OR PERMANENT CUSTODY OR SUPERVISION OF THE DEPARTMENT OF HUMAN SERVICES

317:30-5-990.Eligible providers
[Issued 8-01-97]
(a) Case management agencies. Services are provided by case management agencies established for the purpose of providing case management services. Medicaid Child Welfare Targeted Case Management (CWTCM) services must be made available to all eligible recipients and must be delivered by provider agencies on a statewide basis with procedures that assure 24 hour availability, the protection and safety of recipients, continuity of services without duplication, and compliance with federal and State mandates and regulations related to servicing the targeted population are met in a uniform and consistent manner. The agency must demonstrate that their staff has:
(1) a minimum of five years experience in providing all core elements of case management services including:
(A) individualized strengths and needs assessment;
(B) needs-based service planning;
(C) service coordination and monitoring; and
(D) on-going assessment and treatment plan revision.
(2) a minimum of five years experience in providing case management services that coordinate and link the community resources required by the target population.
(3) a minimum of five years experience in meeting the case management and service needs of the target population.
(4) an administrative capacity to insure quality of services in accordance with State and federal requirements.
(5) a financial management capacity and system that provides documentation of services and costs.
(6) a capacity to document and maintain individual case records in accordance with State and federal requirements.
(7) ability to meet all State and federal laws 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.
(b) Provider agreement. A Provider Agreement between the Oklahoma Health Care Authority and the provider for CWTCM services must be in effect before reimbursement can be made for compensable services.
(c) Qualifications of individual case managers. A targeted case manager for the CWTCM program must:
(1) be employed by the provider agency.
(2) possess at minimum, a bachelor of social work degree; or a bachelor's degree and one year of experience in professional social work; or a master's degree in behavioral science.
(3) possess knowledge of the principles and practices of:
(A) social work;
(B) laws, rules, regulations, and policies and procedures governing agency programs;
(C) community resources;
(D) human developmental stages and related dysfunctions;
(E) sensitivity to cultural diversity;
(F) emotional, physical and mental needs of clients; and
(G) counseling programs and services.
(4) possess skill in:
(A) interviewing;
(B) getting clients to explore opportunities and extracting information;
(C) casework management;
(D) setting goals in cooperation with clients;
(E) time management;
(F) prioritizing and organizing needs of clients;
(G) courtroom testimony, terminology and procedures;
(H) crisis intervention;
(I) working with a multidisciplinary approach; and
(J) developing, evaluating and modifying an intervention plan on an ongoing basis.
(d) Provider selection. Provision of case management services must not restrict an individual's free choice of providers. Eligible recipients must have free choice of providers of case management as well as providers of other medical care under the plan.

317:30-5-991.Coverage by category
[Issued 8-01-97]
Payment is made for case management service as set forth in this Section.
(1) Adults. There is no coverage for adults.
(2) Children. Payment is made for services to persons under age 18 as follows:
(A) Description of case management services. The target group for CWTCM services are persons under age 18 who are in emergency, temporary or permanent custody of the Department of Human Services (DHS) or in voluntary status who are placed in out-of home care or trial adoption.
(i) Case management services are activities that assist the target population in gaining access to needed medical, social, educational and other services. These services include services covered under the Oklahoma Medicaid State Plan as well as those services not covered under the State Plan.
(ii) Case management is designed to assist individuals in accessing services. The client has the right to refuse case management and cannot be restricted from services because of a refusal for Case Management Services.
(iii) Case management does not include:
(I) Physically escorting or transporting a client to scheduled appointments or staying with the client during an appointment;
(II) Monitoring financial goals;
(III) Providing specific services such as shopping or paying bills; or
(IV) Delivering bus tickets, food stamps, money, etc.
(B) Non-Duplication of services. To the extent any eligible recipient in the identified target population are receiving CWTCM services from another provider agency as a result of being members of other covered target groups (i.e., SoonerStart Early Intervention), the provider agency assures that case management activities are coordinated to avoid unnecessary duplication of service.
(C) Providers. Case management services must be provided by case management agencies.
(3) Individuals eligible for Part B of Medicare. Case Management Services provided to Medicare eligible recipients are filed directly with the fiscal agent.

317:30-5-992.Reimbursement
[Revised 03-03-10]
Child Welfare Targeted Case Management (CWTCM) services will be reimbursed pursuant to the methodology described in the Oklahoma Title XIX State Plan.
317:30-5-993.Billing
Revised 09-01-16]

Billing for case management services is on Form HCFA-1500.  Claims must be submitted in accordance with guidelines found at OAC 317:30-3-11 and 317:30-3-11.1.



317:30-5-994.Documentation of records
[Issued 8-01-97]
All case management services rendered must be reflected by documentation in the records. All units of Medicaid CWTCM services provided are documented by the case manager on the monthly Record of Contact form.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.