Developmental Services - Case Management Manual

Case Management Status - Developmental Services

Active status for case management includes people who have been found eligible for Developmental Services and need a case management services as defined below. This determination, made by a Developmental Services Case Management Supervisor is a result of an assessment of their needs through the intake process or through the procedure for Transfer of Case Status. The person may be assigned to inactive or closed status if they meet the criteria. This determination can be made at the conclusion of the eligibility process.

Case Management Services includes the following:

    1. Assessment of the persons medical, social, educational, and other needs. This intake process will include the review of the results of the psychological evaluation; developmental and biographical history, behaviors, traits, and qualities; the persons current circumstances; the resources, services and accommodations provided to the person; the persons significant relationships, problems, requirements, and needs. The assessment will be coordinated by the Case Manager in consultation with the person, other professionals, providers, and family or guardians, as necessary. (See Eligibility and Intake procedure in Case Management Manual).
    2. Development and implementation of a Service Plan under the direction of the person and in accordance with the policies of DHHS.
    3. Coordination of the service providers and resources identified in the Service Plan.
    4. Linkage of the person with appropriate agencies, community resources and informal support systems, including referral to transportation services.
    5. Monitoring the person’s progress toward the achievement of objectives specified in the Service Plan. The plan will be re-evaluated as often as is specified in the plan. The Case Managers will evaluate the person’s status and needs periodically and implement changes in the plan of care, as necessary.

Inactive Status for Case Management

Inactive case management status assigned to people who have been found eligible for Developmental Services, receive services from the department, but do not require case management services at the present time because there is a reliable history of natural supports providing the case management functions. A Developmental Services Case Management Supervisor makes the determination.

The following describe some situations in which inactive case management may be appropriate:

  • No legal involvement or if there is a legal issue the person has an attorney representing them.
    • Not under public guardianship
  • Assistance in managing financial issues.
  • Routine health care that is arranged without the assistance of a case manager.
  • Not utilizing section 21 or 29 and no projected need for those services
  • Healthy relationships with family, friends, natural supports
  • No planning needed or receives from another source such as day program or housing
  • Representative Payee – Service is provided by someone outside the Department.

Monitoring of Inactive Case Management Status

Each District Office will ensure the monitoring of people in inactive case management status. This may be done through a contracted service or by assigning a staff person other than a Case Manager with an active caseload. Monitoring will include at least an annual face-to-face contact with each consumer unless the consumer specifically requests not to be contacted. All such request will be documented. All contacts will be documented in the file. In addition a letter will be sent annually asking the if they are satisfied with the degree and scope of services being provided as well as reviewing their rights, review of the grievance and appeal process, and access to the Disability Rights Center. This letter will identify the district contact person.

The Regional Office will ensure that:

  • There are timely responses to requests made by individuals in this status
  • Assistance in connecting individuals with services in their community is provided when needed.
  • There is adequate monitoring of the level of need and recommendations made to the Case Work Supervisor regarding the need for a change is case management status.
    (See case status change procedure.)

Grievance and Appeal
Any concerns by a consumer or guardian in regards to this case status should be communicated to the Casework Supervisor and/or Disability Rights Center. The Grievance and Appeal procedure (14-197CDMR8) should be followed if agreement cannot be reached.

Closed Status for Case Management
Closed case management status is assigned to persons who have no further need for case management services. The following are situations in which a person can be in closed status in Developmental Services and the implications for accessing services in the future:

  • A person who applies for services is found to be ineligible under 34B MRSA 5465 (refer to referral and intake policy). All intake information and reason for denial will be maintained in the District Office. If the person can provide additional information, primarily within the developmental period that indicates eligibility, the application can be reviewed. The individual has no access to funding or resources of Developmental Services if they are not found eligible for services.
  • The consumer/ guardian after being found eligible for services chooses not to access any services. The consumer/guardian will be notified in writing of the case closure and informed that at any time they choose to reactivate services with the Department that they can do so, and would not have to go through the process of eligibility determination. Prior to closure the case will be reviewed by a District Supervisor to assure that information regarding service requests and PCP action plans were closed, reason for closure was clear, and that the person had been advised that services can be reactivated upon request. The Department may choose not to close a case if adult protective issues are present.
  • The District Office determines that case management services are no longer needed and no other services are being requested or funded. The District Supervisor will review the case to assure that components outlined in Section 13, of the Maine Care Benefits Manual (Adult Developmental Services) or other services provided by the Department are not needed. The case will be reviewed by a District Supervisor to assure that information regarding service requests and PCP action plans were closed, reason for closure was clear, and that the person has been advised that services can be reactivated upon request.
  • The person is eligible for services and moves out of state. Upon request, with appropriate releases, information will be forwarded to service agencies identified by the consumer/guardian. The case will be reviewed by a District Supervisor to assure that information regarding service requests and PCP action plans were closed, reason for closure was clear, and that the person has been advised that services can be reactivated upon request after returning to Maine.
  • The person is deceased. The case will be reviewed by a District Supervisor to assure that information regarding service requests and PCP action plans were closed and the reason for closure was clear.

There is no responsibility for follow-up of cases placed in closed status by Developmental Services.

Discontinuation of Community Case Management

Discontinuation of Community Case Management may occur for several reasons including:

  • The needs of the individual no longer meet the criteria of active case management. (Refer to active case management in procedure manual).
  • The needs of the individual exceed the roles and responsibilities of a community case manager. (Examples include needing public guardianship.)
  • The person moves from the area or the state.
  • The person chooses to leave the organization that they receive case management services from.

Discontinuation of Developmental Services

If a consumer has been receiving case management services from Developmental Services  for sometime, and it is determined that the consumer is no longer in need of case management services every effort will be made to link this consumer up with necessary community services prior to Developmental Services closure. The Case Manager (CM) will be responsible for making referrals to the appropriate community agency. Once referrals are completed, the consumer, guardian (if applicable), service providers, interested family and correspondent will be notified in writing by the CM that the consumer will no longer be provided Developmental Services case management services.

Similarly, if a consumer has been receiving case management services from Developmental Services for some time and it is determined that the consumer does not have a diagnosis of mental retardation or autism, every effort will be made to link this consumer with necessary community or Departmental services prior to Developmental Services closure. Situations such as these may include instances where a consumer was accepted for services on a conditional basis and where further evaluation resulted in the removal of the diagnosis of mental retardation or autism, or where a consumer without a diagnosis of mental retardation or autism had been accepted in the past for services and community services more appropriate to their needs (such as community mental health services) can now be accessed.

The district supervisor, together with the case manager, will review the case and place the consumer in the "closed" status. The reason for closure will be documented in the case record and the EIS.

If a consumer is moving out of state, the CM, after receiving the necessary releases, will be responsible for forwarding appropriate information (personal planning process, clinical reviews, etc) to the receiving state agency. The CM will also notify the local service providers and correspondent that the case is being closed by Developmental Services.

Services may be discontinued at the request of the consumer, and/or the consumer's guardian, unless there are adult protective issues.

The status of the case should be clearly documented in the consumer's record and the EIS.
For consumers /guardians who opt to discontinue Developmental Services services, notice should be given that they may reactivate services upon request.

Services may also be discontinued if the consumer has not received services from Developmental Services in 15 to 18 months. The status of the case should be clearly documented in the consumer's record and the EIS. Notice should be given that they may reactivate services upon request.