Initial Contact/Visit Timeframe Initial Contact (CM or designee) Within seven business days of enrollment Initial on-site visit Within 12 business days of enrollment Initial service Within 30 days of enrollment Case File Updates Timeframe Initial Cost Effective Study (CES) Prior to placement/services Initial CES, when services in place at Within 12 business days of enrollment enrollment Prior to placement change to HCBS and annually for all HCBS members, and when CES update there is a change in the member’s condition, authorized services, or rates. CES when no discharge potential No updates required, CES will reflect “NONE” CATS Entries Timeframes CES/CA160 Within ten business days of date of action Placement/CA161 Within ten business days of date of action Service Plan/CA165 (Tribal only) Within five business days of date of action Reassessment Visits Timeframes (Includes service plan review and signature) HCBS member At least every 90 days Nursing Facility (NF) member At least every 180 days At least every 90 days for home based Care Only members – members may be phone contact but on-site visit required At least every 180 days for institutionalized at least once a year members* Developmentally Disabled (DD) members 12 or older residing in a group home, unless the member is medically involved or Seriously At every 180 days* Mentally Ill/Severely Emotionally Disabled (SMI/SED)
Initial Contact/Visit Timeframe Initial Contact (CM or designee) Within seven business days of enrollment Initial on-site visit Within 12 business days of enrollment Initial service Within 30 days of enrollment Case File Updates Timeframe Initial Cost Effective Study (CES) Prior to placement/services Initial CES, when services in place at enrollment Within 12 business days of enrollment CES update Prior to placement change to HCBS and annually for all HCBS members, and when there is a change in the member’s condition, authorized services, or rates. CES when no discharge potential No updates required, CES will reflect “NONE” CATS Entries Timeframes CES/CA160 Within ten business days of date of action Placement/CA161 Within ten business days of date of action Service Plan/CA165 (Tribal only) Within five business days of date of action Reassessment Visits (Includes service plan review and signature) Timeframes HCBS member At least every 90 days Nursing Facility (NF) member At least every 180 days Care Only members – may be phone contact but on-site visit required at least once a year At least every 90 days for home based members At least every 180 days for institutionalized members* Developmentally Disabled (DD) members 12 or older residing in a group home, unless the member is medically involved or Seriously Mentally Ill/Severely Emotionally Disabled (SMI/SED) At every 180 days*
AMPM-Exhibit-1620-1-Case-Management-CM-Timeframes.docx