Developmental Services - Case Management Manual

Protocol in Word* | PDF*

Protocol for "Approval of Routine Services" by Case Managers representing the Public Guardian 1/20/2010

Purpose: The purpose of this protocol is to provide direction to Individual Support Coordinators (I.S.C.)  who are representing the Public Guardian when they are requested by an agency/provider to sign permission for Routine Services.  Developmental Services supports the use of this method of permission with the understanding that the I.S.C. has the discretion to not sign such an authorization if it does not meet the standards set in this protocol or if the case manager has health and safety/quality assurance concerns and requests that permission is sought for each event. The Case Manager also has permission to identify specific events that they do not approve for authorization under routine services. Developmental Services provides a form for Approval of Routine Services. This is the only form that an I.S.C. as designated representative to the Public Guardian should utilize.

Under the policy for Public Guardianship I.S.C.’s have the following decision making authority:

  1. I.S.C.  Responsibilities:  Most day-to-day functions associated with guardianship and conservatorship are delegated to the ward's ISC.   These duties may include the following:
    1. Attend all personal planning meetings as the designated representative of the public guardian;
    2. Sign individual plans as the designated representative of the public guardian;
    3. Approve routine medical treatment including, but not limited to annual physicals or routine medical examinations, routine lab work (blood tests, x- rays); provide prior approval of treatments and medication as prescribed by a licensed physician.
    4. Handle all routine guardianship responsibilities such as the preparation of annual reports, inventories, or accountings;
    5. Approve emergency medical treatment as necessary to relieve an emergency, including hospital admission, anesthesia and emergency surgery;
    6. Sign permissions for special events; sign routine correspondence including releases of information

The following are examples for routine medical/healthcare services that may be authorized as routine services.

  • Annual Physical Examination with primary care physician (PCP)
  • Annual/Bi-Annual Eye Examination as needed
  • Mammogram as ordered by primary care physician (PCP)
  • Routine Blood Work as determined by primary care physician (PCP)
  • Routine Dental Cleanings, Exams and other preventative Dental Care (additional consent will be obtained for higher level procedures prior to appt on a separate release form)
  • Routine Podiatry Services as determined by primary care physician (PCP)
  • Routine Psychiatric Medication Reviews
  • Routine Psychological Reviews as determined by primary care physician (PCP)
  • Non-Routine appointments to primary care physician (PCP) for minor ailments, such as seasonal colds, skin irritations, etc.
  • Routine Specialist follow up (i.e. Annual Urology/Neurology/Orthopedics, etc)

Further Guidelines for I.S.C.’s:

  • The I.S.C. signs the Person Centered Plan which provides approval for services identified in the plan. It is therefore not necessary for "program related" activities that are identified in the plan to be in a routine authorization. While healthcare services are also identified in the plan it is clear that most providers require a more specific approval for these services and the Department supports this requirement.
  • Routine is described as any practitioner that the individual is established with at the time the release is signed by the guardian.  Additional appointments and new practitioners will be approved on a separate release prior to the appointment.  The legal guardian should be notified promptly of any identified concerns.  Additional guardian consent would be required if the nature of the appointments change.  Guardian consent will be obtained prior to following through with any treatment prescribed by the treating professional – related to medications, additional services required, etc.
  • A consent to authorize routine medical/healthcare appointments is effective for one year and may be revoked at any time.
  • If the I.S.C. has concerns regarding signing an authorization they should review it with their Supervisor. If further concern exists the Supervisor and I.S.C.  should consult with the Public Guardianship Manager.