Sec. 10.09.40.04. Covered Services

A. The Program shall reimburse for the services in §§B, C, and D of this regulation, when they have been documented as necessary.

B. Initial Case Management Services.

(1) A unit of service is defined as a completed initial Individualized Family Service Plan (IFSP) and at least one contact with the participant or the participant's family, in the participant's behalf.

(2) The covered services include convening and conducting a multidisciplinary team to:

(a) Perform a multidisciplinary assessment; and

(b) Develop an initial IFSP for a participant that identifies the:

(i) Participant's needs for early intervention, medical, mental health, social, educational, financial assistance, counseling, and other support services,

(ii) Responsibilities and rights of the participant and the family,

(iii) Provider's responsibilities, and

(iv) Resources available to provide the needed services.

(3) Administrative, supervisory, and monitoring services associated with the initial case management service are included as part of the service.

C. Ongoing Case Management Services.

(1) Ongoing case management service is provided following the initial case management services.

(2) A unit of service includes a monthly telephone call to, or visit with, the participant's family, in the participant's behalf, and all other necessary covered services.

(3) These services include:

(a) Maintaining contact with a participant and the family through home visits, office visits, telephone calls, and follow-up services as necessary;

(b) Referring the participant to direct service providers, assisting the participant in gaining access to services specified in the IFSP, and providing linkage to agreed-upon direct service providers of early intervention services;

(c) Discussing with direct service providers of early intervention services the services needed and available for the participant, determining the quality and quantity of service being provided, following up to identify any obstacles to a participant's utilization of services, coordinating the service delivery, and performing ongoing monitoring to determine whether the recommended services are being delivered and meet the participant's current needs;

(d) Providing a participant's family with information and direction that will assist the participant in successfully accessing and using the services recommended in the IFSP;

(e) Informing a participant's family of the participant's and the family's rights and responsibilities in regard to specific programs and resources;

(f) Conducting, with a participant's family, a periodic review of the participant's IFSP every 6 months, or more frequently if conditions warrant or the family requests a review;

(g) A periodic review accomplished at a meeting or by other means acceptable to the family and others involved in the review process, and which determines the following:

(i) The degree of a participant's progress toward achieving the goals established in the IFSP, and

(ii) Whether the goals or recommended services need to be revised; and

(h) Being available to the participant and the family on a nonscheduled basis as necessary for problem resolution and crisis management related to the participant's needs.

(4) Administrative, supervisory, and monitoring services associated with the ongoing case management services are included as part of the service.

D. Annual IFSP Review.

(1) A unit of service is defined as a completed annual IFSP review and at least one contact with the participant or the participant's family, in the participant's behalf.

(2) The covered services include convening and conducting a multidisciplinary team to:

(a) Perform a multidisciplinary reassessment of the participant's status and service needs; and

(b) Review and revise, as necessary, the participant's IFSP.