OAR 411-028-0020: Scope of Case Management Services

(1) DIRECT CASE MANAGEMENT SERVICES. Direct case management services are provided by a case manager or higher level staff, who communicates directly with an individual or the individual's representative. Direct case management services may occur by phone call, face-to-face contact, or email. Direct case management services do not include contact with collateral contacts unless the collateral contact is the individual's authorized representative. Direct case management services include: (a) An assessment as described in OAR 411-015-0008. (b) Service Plan development and review as described in OAR 411-015-0008. (c) Service options choice counseling as described in OAR 411-030-0050. (d) Risk assessment and monitoring: (A) Identifying and documenting risks; (B) Working with an individual to eliminate or reduce risks; (C) Developing and implementing a Risk Mitigation Plan; (D) Monitoring risks over time; and (E) Making adjustments to an individual's Service Plan as needed. (e) Diversion activities. This means assisting an individual with finding alternatives to nursing facility admission. (f) Other program coordination. This means helping an individual navigate or coordinate with other social, health, and assistance programs. (g) Crisis response and intervention. This means assisting an individual with problem resolution. (h) Service provision issues. This means assisting an individual with problem solving to resolve issues that occur with providers, services, or hours that don't meet the individual's needs. (2) INDIRECT CASE MANAGEMENT SERVICES. Indirect case management services are services provided by a case manager or higher level staff, in which direct contact with an individual is not occurring. Indirect case management services include: (a) Monitoring Service Plan implementation. Reviewing implementation of an individual's Service Plan by reviewing and comparing authorized and billed services to ensure that adequate services are being provided. (b) Service options choice counseling. This means assisting an individual's caregiver, family member, or other support person with understanding all available Medicaid home and community-based service options. (c) Risk monitoring. Working with a collateral contact to review an individual's risks, eliminate or reduce risks, and develop and implement a Risk Mitigation Plan. Adjustments to an individual's Service Plan based on risk monitoring activities are classified as direct case management. (d) Diversion activities. This means finding alternatives to nursing facility admission. Diversion activities do not include transition activities to help an individual move from a nursing facility. (e) Adult protective services referral including collateral contact. (f) Other program coordination. This means helping collateral contacts navigate or coordinate with other social, health, and assistance programs. (g) Service provision issues. This means assisting with problem solving issues that occur with providers, services, or hours that do not meet an individual's needs. (h) Other case management activities not included in any criteria in this section of the rule.