Case Management Standards

Standards Guide - Access and Time Frame

Case management services must be accessed through Mental Retardation Services through the Intake and Referral Policy as follows:

Referral And Intake

I. Introduction

Intake is a process by which a person with mental retardation/autism/or pervasive developmental disorder and Mental Retardation Services establish a formal relationship.

People referred to the Department are considered to be in intake status until eligibility is determined. Eligibility is defined in the MR services policy entitled Eligibility for Mental Retardation Services. (34B MRSA Section 5465) People are eligible for MR services for adults at the age of 18.

Foreign language and/or sign language interpreters must be utilized whenever there is a communication barrier to comply with Federal and State Laws concerning equal access to service.

II. Referral

A. The referral/intake process begins when a request for MR services is made by a person with mental retardation/autism or PDD or by any person or agency acting on behalf of the person who is not currently or has not in the past received services from MR services. The consumer and/or guardian must consent to the referral unless it is an Adult Protective Referral. This consent can be given by the person or guarding over the phone. Persons acting on behalf of the individual must provide a sign release prior to information being accepted by BDS.

B. Each regional office has established a procedure whereby a referral can be accepted at any time so that a person making a referral is not required to re-contact the regional office. The staff person accepting the initial referral is responsible for completing the referral information used by a regional office. While completing this form, the staff person should attempt to determine the applicant’s circumstances and need for services, how the applicant may be contacted, the possible need for emergency intervention, as well as the identifying information indicated on the form. The staff person accepting the referral should be sufficiently aware of MR Services to answer general questions regarding services.

III. Intake

A. The referral information is forwarded to the regional supervisor who assigns responsibility for completion of the intake process to the appropriate staff person. This person will be referred to as the intake worker. Eligibility may be determined at any point during the referral/intake process once enough information is available to ascertain the eligibility of the individual.

B. The intake worker assigned will proceed promptly with all prescribed intake activities. The initial contact will take place within 10 working days of the initial referral. For Adult Protective referrals, action should be taken as soon as possible. Specific actions to be taken in this situation are outlined in the cooperative agreement between MR Services and Adult Protective. Copies of this are available in each regional office. The intake worker shall contact the applicant, or other informant, in order to obtain Permission for Service. The Permission for Service form establishes the basis for an ongoing relationship between the applicant and MR Services. The form permits MR Services to act on behalf of the person with mental retardation. The competent adult with mental retardation/ autism/PDD should sign the permission for himself or herself. The term “competence” used here implies the ability of the client to understand the nature of the services to be provided, and the appropriateness of such services for himself or herself. In some cases, incompetence may have already been determined by the court and therefore, the person will have a court appointed guardian. The working assumption is that if legal incompetence has not been established by the court the applicant is, therefore, competent. Competence may later be clarified by court action. A competent person with mental retardation or his legal guardian may decline MR Services.

The date of the sign permission shall be considered the date that the intake process has begun. At this time the intake worker will determine whether a visit is necessary at this time or at a later date. If the individual is already receiving case management from Children’s Services as an example it may not be necessary to do a visit if all relevant information is available for intake.

C. If available information from the source of referral indicates that pre-arrangement of the visit is not advisable, this fact should be noted and documented. The goals of a visit are: the functional assessment of the applicant, the compilation of historical and biographical information regarding the applicant, and the completion of various forms related to the intake. The selection of the site of the visit should be in an environment familiar and comfortable for the applicant in order to gain the greatest insight regarding the applicant’s behavior, needs, and abilities; the need for emergency intervention; or the availability of an informant. Based upon what is known about the applicant and his or her circumstances, consideration of the above factors may indicate that one setting is more expedient, or that one setting may yield the most relevant information.

D. It is not intended that the intake worker will make a diagnosis of mental retardation/autism or pervasive developmental disabilities (PDD). The primary purpose of the intake is to gather information in order to determine eligibility. In addition, information is collected to assist in preliminary service planning. To these ends, the intake worker shall:

  1. Collect pertinent demographic data
  2. Determine the nature and type of services already provided to the person
  3. Identify service needs
  4. Collect information regarding developmental history and current living arrangements
  5. Determine what information will be needed to establish eligibility
  6. Provide the referral source an opportunity to receive an explanation of MR services
  7. Provide services or referral for singular immediate needs particularly regarding health and safety.
  8. Begin to gather information for a service plan.

IV. Intake Documenation

A. The intake worker is responsible for the completion of various required documents.

The forms to be completed include:

  1. The information sheet on EIS
  2. The Permission for Service;
  3. The Release of Information, (to);
  4. The Release of Information, (from), as required; and
  5. Intake assessment.In addition, the intake worker will arrange for a psychological evaluation unless current copies can be obtained from another source.

B. Information Sheet

The information sheet (EIS) is completed at the intake. The form serves as a source of information regarding the applicant. Upon acceptance of the applicant for services, the form will become the face sheet for the case record.

C. Release of Information (to)This form gives permission for MR Services to release specific information to a designated person or agency. A separate release is required each time information is disclosed. The original signed release stays in the case record.

D. Only records or information which are generated by MR services and which will not be harmful to the consumer may be authorized for release. All such information should be stamped “Privileged and Confidential Information, Not to be Used Against Client’s Best Interest”.

E. Release of Information (from)

This form authorizes the release of information generated by the primary source to MR Services. The release is specific to the agency noted in the release and the information requested. A separate release should be completed for each agency from which information will be requested. It should be understood that the release form authorizes the one-time release of information from the primary source, and that the authorization is specific to the information specified on the form. When requesting additional information from a particular agency, a new Release of Information form should be completed. The intake worker should insure that the “to” section on the release is filled in prior to asking an applicant or legal guardian to sign. The original signed form will be sent to the agency from which information is requested.

F. Intake Assessment

This document provides the structure to the assessment phase of the intake process. It provides a basis for a psychosocial evaluation of the prospective client.

V. Establishing the Need for Evaluation

A. An updated psychological evaluation may be requested at the discretion of the Regional Supervisor in order to determine a diagnosis of mental retardation/autism. This may be particularly necessary in the referral of children transitioning to adult services considering the potential for growth and achievement. A licensed Ph.D., psychologist or a licensed psychological examiner, must conduct the evaluation. Additional professional assessments may include physical examination, psychiatric evaluation, physical therapy evaluation, occupational therapy evaluation, speech and hearing evaluation, etc. Foreign language and/or sign language interpreters must be utilized whenever there is a communication barrier to comply with Federal and State Laws concerning equal access to service.

C. The intake worker, through observation and interview, may determine areas where further evaluation may be useful. Certain professional evaluations may be indicated solely on the basis of the timeliness of the available information. Other needs for evaluation may become obvious during the intake process. Evaluations requested that are not directly related to determination of eligibility should not delay a decision being made within the accepted time frame.

D. The intake process should be completed within 60 days. The end date for completion is date of a letter of eligibility. If the process can not be completed within 60 days a letter will be provided to the applicant explaining that eligibility has not been determined and providing specific information as to why with a projected completion date. The office of Advocacy will be notified. If at the projected date the eligibility cannot be determined the applicant will be contacted again in writing explaining the reason for a decision not being made with another projected date. The office of Advocacy will again be notified.

VI. Disposition of a Referral

A. Once the intake worker has completed the intake assessment and other necessary forms, and has obtained a current psychological evaluation, the intake worker will meet with the regional supervisor to discuss all of the relevant information obtained by the intake process.

B. Denial of Services

  1. If the Regional Supervisor determines that the applicant does not meet the established criteria, (See Eligibility for Mental Retardation Services in Case Management Manual) the person will be denied mental retardation services. To the greatest extent possible, the intake worker and the Regional Supervisor will attempt to suggest to the applicant or to the referral source, alternative services.
  2. The applicant and/or the individual acting on behalf of the applicant shall be informed of the denial in writing and when necessary via other appropriate means, and given notice of their right to appeal that decision and of the availability of the Office of Advocacy to provide assistance. (See Eligibility for Mental Retardation Services in Case Management Manual)

C. Acceptance for Services

  1. If the Regional Supervisor determines that the applicant meets the eligibility criteria, he or she will be accepted for MR Services. The Regional Supervisor and intake worker will determine the case management status based on the criteria in the case status procedures.
    (See case management status procedures active, inactive, closed in case management manual.) The person will be informed in writing of their eligibility and will be provided with:
    a. A statement of rights, information about the grievance process and the availability of the Office of Advocacy;
    b. Information about the case status to which the person has been assigned;
    c. If assigned to Active status, the name of the ISC and contact information. For all other statuses, the name and title of a person to contact.
  2. A psychosocial will be written by the intake worker for transfer to case management or to the person covering the inactive case status.

The intake worker for transfer to case management or inactive case status will write an initial service plan. (If an applicant had not met with a representative of the department until acceptance, a meeting will occur at this time to review needs and develop a service plan.)

Referral to Private Case Management:

When eligibility determination is made and case management services is identified, as a need the service needs to be provided within 90 days. The Regional Supervisor will make a determination as to whether the person meets the criteria for community case management. If this is the case the following steps will be taken:

A. Inform the person in writing of their right to access case management services through a community provider. The option of state case management services will be identified at the time of eligibility and will be contingent on ratios within the regional office of origin.

B. Provide the person/guardian with information regarding agencies providing this service in their community.

C. Arrange for interviews by the person/guardian of case management agencies.

VII. Personal Planning Policy

A. Community Support Coordinators will plan with individuals for the coordination and delivery of supportive and other services through the development of a personal plan. The type of plan, participants and agenda at the planning meeting will be selected by the individual and/or their guardian.

B. The personal planning process will be:

  1. Understandable and in plain language or if the individual is deaf, non-verbal, signing, or speaks another language; the process will include qualified interpreters.
  2. Focused on the person’s choice
  3. Reflective of and supportive of the person’s goals and aspirations
  4. Developed at the direction of the consumer and include people the consumer chooses
  5. Flexible enough to change as new opportunities arise
  6. Reviewed according to a specified schedule and by a person designated for monitoring
  7. Inclusive of the needs and desires of the person without respect to whether those desires are reasonably achievable or the needs are presently capable of being addressed
  8. Inclusive of a provision for assuring each person’s satisfaction with the quality of the plan and the supports he/she receives

C. The plan will focus on the supports identified by the individual.

D. The plan will be written and approved by the consumer/guardian and the action plan will be entered in EIS within 30days of the meeting date.

E. The plan may be facilitated by the consumer, a case manager, other agencies providing major services to the individual, family members or other persons chosen by the consumer.

F. The planning team will always develop a service plan or action plan which outlines the agreements reached by the team. The planning team will follow the needs/desires policy in regards to time frames for identified needs and interim plans for unmet needs.

VIII. Personnel

A. Qualifications

A case manager must have a minimum of a bachelor’s degree from an accredited four (4) year institution of higher learning with a specialization in psychology, behavioral health, social work, special education, counseling, rehabilitation, nursing, or a closely related field.

B. Supervision

A supervisor of case management must have a baccalaureate degree plus a minimum of four years experience in the mental retardation field. The supervisor must also have experience supervising staff providing services to persons with mental retardation, knowledge of the public education system in Maine, and training in flexible funding and family-focused service provision. Supervisors are responsible for supervising individual support coordinators or case managers, developing and reviewing service plans, and assuring the provision of quality case management services.

The agency must have policies and procedures regarding the provisions of supervision of Case Managers. The policies and procedures must address the need for a minimum of ________ a month of supervision with access

IX. Confidentiality

X. Discontinuation of Community Case Management

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

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

1. In the event that case management considered to be no longer needed this would be identified in the persons plan and would be referred to a regional Supervisor for review for inactive status and the following procedures would occur.

Inactive case management status assigned to people who have been found eligible for Mental Retardation Services, receive services from the department, (ex. Day hob, respite, family support) 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 Mental Retardation 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 a class member
  • A class member who has refused case management services. If annual follow-up is refused case will be placed in closed status.
  • Not under public guardianship
  • Assistance in managing financial issues is not needed or assistance is available.
  • Routine health care that is arranged without the assistance of a case manager.
  • Program/work/housing are stable
  • Healthy relationships with family, friends, natural supports
  • No planning needed or receives from another source such as day program or housing
  • Representative Payee – someone outside the Department provides Service.

Monitoring of Inactive Case Management Status

1. Each Regional 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 an Individual Support Coordinator 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 Office of Advocacy. This letter will identify the regional 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.)

2. If the needs of the person exceed what the community case manager can provide those needs have to be identified in the person centered planning process. A review of the case would occur between the community case managers supervisor and the liaison for Mental Retardation Services as well as a Regional Supervisor for Mental Retardation Services. A determination will be made within 30 days of the request for review as to whether case management should be transferred to State case management.

3. If the person is moving to another area of the state resulting in the need to change the community case manager/agency it is the responsibility of the case manager to facilitate that transfer by identifying potential providers of the service in the area and arranging for interviews by the person/family. It is also the responsibility for the case manager to inform the local BDS office as well as the office in the region the person is moving to.

If the person is moving out of state it is the responsibility of the case manager to assist in connecting to potential service providers in the state the person is moving to if requested by the person/guardian as well as providing notice to the BDS office as soon as the case manager is informed. When case management ends, presumably when the person leaves the state, the case should be closed. (See Closed Status for Case Management)

4. If a person request a change in case manager or agency it is the responsibility of the person and their family to give a 30-day notice to the case manager. It is then the responsibility of the case manager to assist the person /family to identify a new service.