Sec. 10.09.45.07. Limitations

A. Mental health case management services are advisory in nature.

B. A restriction may not be placed on a qualified recipient's option to receive mental health case management services.

C. Mental health case management services do not restrict or otherwise affect:

(1) Eligibility for Title XIX benefits or other available benefits or programs, except as limited by §E of this regulation;

(2) The freedom of a participant to select from all available services for which the participant is found to be eligible; or

(3) A participant’s free choice among qualified providers.

D. Mental health case management providers may not bill the Program for:

(1) The direct delivery of an underlying medical, educational, social, or other service to which a participant has been referred;

(2) Activities integral to the administration of foster care programs;

(3) Activities not consistent with the definition of case management services under Section 6052 of the federal Deficit Reduction Act of 2005 (P.L. 109-171);

(4) Activities for which third parties are liable to pay; or

(5) Activities delivered as part of institutional discharge planning.

E. Reimbursement may not be made for mental health case management services if the participant is receiving a comparable case management service under another Program authority.

F. A participant's case manager may not be the participant's family member or a direct service provider for the participant.