Family and Children's Medicaid MA-3540 Medicaid Covered Services
Xliii. Case Management for adults and children at risk of abuse, neglect, and exploitation (At-risk case management)
Refer to DMA’s website at http://www.dhhs.state.nc.us/dma/mp/mpindex.htm for specific coverage criteria, prior approval requirements, and service limitations.
A. Covered Services
Targeted case management services for at-risk adults and children are a group of interrelated activities under which responsibility for locating, coordinating, and monitoring appropriate services for an individual rest with a specific person or organization. The activities include those specified below.
1. Evaluating recipient’s situation to determine the need for initial or continuing case management services
2. Assessing and reassessing the service needs of the recipient
3. Developing and implementing a client/family service plan to meet the service needs of the recipient
REVISED 08/01/11 – CHANGE NO. 14-11
4. Assisting the recipient in locating and contacting providers and programs for needed services
5. Coordinating delivery of services when multiple providers or programs are involved in care provision
6. Monitoring services to ensure that they are received and adequate to meet recipient's needs and are consistent with quality care
1. Medicaid recipients are not eligible for at-risk case management while in a hospital or in a nursing facility.
2. Medicaid recipients are not eligible for at-risk case management if receiving one of the following:
a. Community Alternatives Program for children (CAP/C), disabled adults (CAP/DA), CAP/Choice and mentally retarded/developmentally disabled (CAP-MR/DD)
b. Targeted case management provided to the chronically mentally ill and the developmentally disabled
3. Recipients eligible for Protective Services through dss are covered for at-risk case management services.