CARE PLANNING AND CASE MANAGEMENT

A. Home Care Allowance may be used to purchase: 1. Non-skilled assistance with activities of daily living, as defined in Section 3.570.15; and; 2. Electronic monitoring, such as an emergency alert button; and, 3. One-time deep cleaning if a referral is initiated by Adult Protective Services and determined necessary by the CMA. B. The CMA shall develop a care plan on the State Department prescribed form within ten (10) working days after program eligibility has been determined and prior to the arrangement for services. 1. The care plan shall be: a. Signed by the client, CMA, and the service provider; and, b. Reviewed and updated at least once every twelve months; and, c. Reviewed sooner if there is a change in the client's needs; and, d. Provided to all parties. 2. Care planning shall include, but not be limited to, the following tasks: a. Identifying and documenting care plan goals and client choices. b. Identifying and documenting services, including type, duration and frequency. c. Arranging for services through a service provider, family member, or other provider of the client's choosing. 1) Providers shall be at least eighteen (18) years of age or older and have the ability to provide appropriate services. 2) The CMA shall negotiate with the client and care provider to arrive at the total number of paid care hours to be provided monthly. 3) The HCA payments shall be made directly to the client or authorized representative who shall pay the provider the agreed upon, authorized amount monthly. 4) No portion of the authorized HCA amount shall be withheld by the client for personal use. The entire HCA authorized amount shall be spent for HCA allowable services. d. Coordinating service delivery, negotiating with the service provider and the client regarding service provision, and formalizing the provider agreement. e. Completing program requirements for the authorization of services. f. Referring the client to community resources, as needed, and attempting to develop resources for the client if a resource is not available within the client's community. g. Explaining the complaint procedures to the client, as listed on the care plan document. h. Explaining the client's right to appeal any decision. 3. The CMA shall meet the client's needs, with consideration of the client's choices, using the most cost effective methods available. a. When services are available to the client at no cost from family, friends, volunteers, or others, these services shall be utilized before the purchase of services, providing these services adequately meet the client's needs. b. When public dollars must be used to purchase services, the CMA shall assist the client in comparing the cost of services. c. The CMA shall ensure there is no duplication in services provided by any other public or privately funded services. d. The CMA shall discuss with the client if other waivers and/or services are more appropriate or beneficial to the client and assess as needed. C. The CMA shall provide ongoing case management, as follows: 1. Monitoring the quality of care provided to the client. 2. Contacting service providers concerning service coordination, effectiveness, and appropriateness. 3. Reviewing the client's assessment, care plan, and service agreements to include changes in client functioning, service effectiveness, appropriateness, and cost-effectiveness that may require a reassessment or a change in the care plan. 4. Making changes in care plans as appropriate to client needs and/or referring the client to community resources, if appropriate. 5. Providing conflict resolution and/or crisis intervention, as needed. 6. Identifying and contacting appropriate individuals, and resolving any problems or complaints raised by the client or others regarding service delivery. 7. Notifying the appropriate law enforcement and/or child/Adult Protective Services agency of suspected abuse, neglect or exploitation, as required by Sections 18-6.5 108, 19-3-304 and 26-3.1-102, C.R.S. D. The CMA shall complete a review of the client's current assessment or reassessment and the care plan with the client six months following the assessment or reassessment. 1. The review shall be conducted by telephone, at the client's place of residence, at the place of service, or other appropriate setting as determined by the client's needs. 2. An in-person home visit shall be completed when significant changes in the client's condition are identified. E. The CMA shall complete an in-person functional reassessment within twelve (12) months of the initial functional assessment and every twelve months thereafter. A reassessment shall be completed sooner if the client's condition changes. F. Reassessment shall include the following tasks: 1. Reviewing the care plan, service agreement, and provider contract or agreement. 2. Evaluating service effectiveness, quality of care, and appropriateness of services. 3. Verifying continuing financial and program eligibility. 4. Annually, or more often if indicated, completing a new care plan and service agreement. 5. Referring the client to community resources, as needed; and 6. Discussing with the client if a HCPF waiver and/or service is more appropriate or beneficial and assess as needed. G. The CMA shall update the information provided at the previous assessment or reassessment, utilizing the State Department prescribed form and the State prescribed system. When a new functional assessment is completed a copy shall be sent to the county department within ten (10) working days of the reassessment.