§ 36-2938 — Case management; definition

A. The director shall adopt rules establishing a uniform statewide case management program to ensure the most appropriate placement and cost effective delivery of services to members by the program contractors pursuant to this article. The case management program shall include the development by the program contractor of a long-term care service plan for each member. This plan shall include a cost benefit analysis for institutional or home and community based services. In developing this plan, the program contractor may use the information obtained from the preadmission screening conducted pursuant to section 36-2936 to determine the types of services a member should receive.

B. Each program contractor shall provide continual case management services to members in compliance with the uniform statewide case management program established pursuant to subsection A of this section.

C. Except for retroactive coverage, a program contractor shall only provide payment or reimbursement for services provided pursuant to this article under referral from its case management unit.

D. For the purposes of this section, "case management" means a service that will direct members to the most appropriate amount, duration and type of services and continually monitor and reassess a member's need for services provided pursuant to this article.