STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM. State of Colorado

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1 Page 1 f5 Taraet Grup Targeted case management services will be prvided t alchl r ther drug dependent Medicaid clients wh need assistance in btaining necessary scial educatinal vcatinal and ther services Areas f state in which services will be prvided x Entire State Only in the fllwing gegraphic areas authrity f sectin 1915 g 1 is invked t prvide services less than Statewide f the Act Cmparabilitv f services 2L Services are prvided in accrdance with sectin 1902 a 10 8 f the Act Services are nt cmparable in amunt duratin and scpe Definitin f services Case management services are services furnished t assist individuals eligible under the State Plan in gaining access t needed medical scial educatinal and ther services Case Management includes the fllwing assistance Cmprehensive assessment and peridic reassessment f individual needs t determine the need fr any medical educatinal scial r ther services These assessment activities include taking client histry identifying the individuals needs and cmpleting related dcumentatin and gathering infrmatin frm ther surces such as family members medical prviders scial wrkers and educatrs if necessary t frm a cmplete assessment f the individual Apprval Date FEB Effective Date ijul l 1 2Ul

2 Page 2 f5 Develpment and peridic revisin f a specific care plan that is based n the infrmatin cllected thrugh the assessment specifies the gals and actins t address the medical scial educatinal and ther services needed by the individual includes activities such as ensuring the active participatin f the eligible individual and wrking with the individual r the individual s authrized health care decisin maker and thers t develp thse gals and identifies a curse f actin t respnd t the assessed needs f the eligible individual Referral and related activities t help an eligible individual btain needed services including activities that help link an individual with medical scial educatinal prviders r ther prgrams and services that are capable f prviding needed services such as making referrals t prviders fr needed services and scheduling appintments fr the individual Mnitring and fllw up activities activities and cntacts that are necessary t ensure the care plan is implemented and adequately addresses the individuals needs and which may be with the individual family members prviders r ther entities r individuals and cnducted as frequently as necessary and including at least ne annual mnitring t determine whether the fllwing cnditins are met services are being furnished in accrdance with the individual s care plan services in the care plan are adequate and there are changes in the needs r status f the individual and if s making necessary adjustments in the care plan and service arrangements with prviders Apprval Date FEe z Effective Date IUL 0 1 ZQ08

3 Page 3 f5 Case management may include cntacts with nn eligible individuals that are directly related t identifying the needs and supprts fr helping the eligible individual t access services Qualificatins f prviders Apprved services must be prvided and recmmended by a practitiner that ffers a substance abuse specialty Services will be ffered in facilities that have been licensed by the Alchl and Drug Abuse Divisin ADAD f the Department f Human Services r by physicians r ther identified licensed practitiners f the healing arts licensed and certified by Department f Regulatry Agencies DORA r natinally licensed and certified by the Natinal Assciatin f Alchl and Drug Abuse Cunselrs NAADAC the American Sciety faddictin Medicine ASAM r the American Bard f Psychiatry and Neurlgy ABPN Freedm f chice The State assures that the prvisin f case management services will nt restrict an individual s free chice f prviders in vilatin f sectin 1902 a 23 f the Act 1 Eligible recipients will have free chice fthe prviders f case management services within the specified gegraphic area identified in this plan 2 Eligible recipients will have free chice f the prviders f ther medical care under the plan Access t Services The State assures that case management services will nt be used t restrict an individual s access t ther services under the plan The State assures that individuals will nt be cmpelled t receive case management services cnditin receipt f case management services n the receipt f ther Apprval Date FEe Effective Date tj Il

4 Page 4 f5 Medicaid services r cnditin receipt f ther Medicaid services n receipt management services f case The State assures that individuals will receive cmprehensive case management services n a ne t ne basis thrugh ne case manager The State assures that prviders f case management services d nt exercise the agency s authrity t authrize r deny the prvisin f ther services under the plan The State assures that case management is nly prvided by and reimbursed t cmmunity case management prviders The State assures that Federal Financial Participatin is nly available t cmmunity prviders and will nt be claimed n behalf f an individual until discharge frm the medical institutin and enrllment in cmmunity services Case Recrds Prviders maintain case recrds that dcument fr all individuals receiving case management the fllwing the name f the individual dates f the case management services the name f the prvider agency if relevant and the persn prviding the case management service the nature cntent units f the case management services received and whether gals specified in the care plan have been achieved whether the individual has declined services in the care plan the need fr and ccurrences f crdinatin with ther case managers the timeline fr btaining needed services and a timeline fr reevaluatin f the plan Pavment Payment fr case management services under the plan des nt duplicate payments made t public agencies r private entities under ther prgram authrities fr this same purpse TN N Supersedes TN N Apprval Date FEB Effective Date JUL e 1 1

5 Page 5 f5 Case management prviders are paid n a unit f service basis that des nt exceed 15 minutes A detailed descriptin f the reimbursement methdlgy identifying the data used t develp the rate is included in Attachment 4 19B Limitatins Case Management des nt include the fllwing Case management activities that are an integral cmpnent f anther cvered Medicaid service The direct delivery f an underlying medical educatinal scial r ther service t which an eligible individual has been referred Activities integral t the administratin f fster care prgrams Activities fr which an individual may be eligible that are integral t the administratin f anther nn medical prgram except fr case management that is included in an individualized educatin prgram r individualized family service plan cnsistent with sectin 1903 c f the Scial Security Act Apprval Date FEe l Effective Date JUL 0 1 Z008

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