Case Management & Performance Monitoring

Settlement Agreement Provision

  1. Case Management
    1. The Commonwealth shall ensure that individuals receiving HCBS waiver services under this Agreement receive case management.
    2. For the purposes of this agreement, case management shall mean:
      1. Assembling professionals and nonprofessionals who provide individualized supports, as well as the individual being served and other persons important to the individual being served, who, through their combined expertise and involvement, develop Individual Support Plans (“ISP”) that are individualized, person-centered, and meet the individual’s needs;
      2. Assisting the individual to gain access to needed medical, social, education, transportation, housing, nutritional, therapeutic, behavioral, psychiatric, nursing, personal care, respite, and other services identified in the ISP; and
      3. Monitoring the ISP to make timely additional referrals, service changes, and amendments to the plans as needed.
    3. Case management shall be provided to all individuals receiving HCBS waiver services under this Agreement by case managers who are not directly providing such services to the individual or supervising the provision of such services. The Commonwealth shall include a provision in the Community Services Board (“CSB”) Performance Contract that requires CSB case managers to give individuals a choice of service providers from which the individual may receive approved waiver services and to present practicable options of service providers based on the preferences of the individual, including both CSB and non-CSB providers.
    4. The Commonwealth shall establish a mechanism to monitor compliance with performance standards.

The Commonwealth shall include a term in the annual performance contract with the CSBs to require case managers to continue to offer education about less restrictive community options on at least an annual basis to any individuals living outside their own home or family’s home (and, if relevant, to their Authorized Representative or guardian).

Within 12 months from the effective date of this Agreement, the Commonwealth shall establish a mechanism to collect reliable data from the case managers on the number, type, and frequency of case manager contacts with the individual.

Within 24 months from the date of this Agreement, key indicators from the case manager’s face to face visits with the individual, and the case manager’s observations and assessments, shall be reported to the Commonwealth for its review and assessment of data. Reported key indicators shall capture information regarding both positive and negative outcomes for both health and safety and community integration, and will be selected from the relevant domains listed in Section V.D.3 above.


About Case Management

Case management, also referred to as Support Coordination, is a critical service for people with developmental disabilities who have active needs or who receive DD Waiver Services. In Virginia, case management is provided as an option under the Medicaid State Plan to any individual who meets criteria for the service.  Core activities of case management services include:

  • assessing and planning of services
  • linking to services and supports identified in the individual support plan
  • assisting directly for the purpose of locating, developing, or obtaining needed services and resources
  • coordinating services and service planning 
  • enhancing community integration
  • making collateral contacts to promote the individual support plan and community integration
  • monitoring to assess ongoing progress and ensuring that authorized services are delivered; and
  • educating and counseling to guide the development of supportive relationships that promote the individual support plan.

About Case Management Performance Monitoring

The Department of Behavioral Health and Developmental Services oversees the required quality assurance and quality improvement functions with respect to case management (service coordination) services provided to individuals on the DD Waivers.  The Department created a Case Management Steering Committee to coordinate these functions and review all data produced by or about case management to ensure quality service delivery.   The findings and recommendations of the Steering Committee are reported to the Department’s Quality Improvement Committee quarterly and included in the Quality Management Annual Report and Program Evaluation.

Section V.F of the Settlement Agreement includes requirements of the Commonwealth with respect to specific requirements for monitoring the quality of case management performance. 

Authorizing Authority

CMS State Plan Amendments

Delegation

Rules and Regulations for Licensing Providers by the Department of Behavioral Health and Developmental Services, 12VAC35-105

Processes, Protocols and Standards

WaMS ISP Data Reporting Requirements

Case Management Quality Review (CM Performance Monitoring)

Guidelines, Charters, Plans, Other

Instruments and Tools

Case Management Training Modules

For more information about Case Management & Performance Monitoring:

Individuals and families can contact their local CSB/BHA to ask about case management/support coordination. If a DD waiver screening has not been completed, a SC will guide them through the process of determining eligibility.  https://vacsb.org/csb-bha-directory/

Overview of the Case Management Steering Committee

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