Case Management

(provided by Harris Community Care funded thru the WV Aged & Disabled Program)

Case Management includes the coordination of services that are individually planned and arranged for client/members whose needs may be life-long. The practices of case management helps to avoid duplication and provision of unnecessary services, and to services are not provided directly by the Case Management Agency (CMA), the Case Manager (CM) serves as an advocate and coordinator of care for the client/member. This involves collaboration with the ADW client/member, family client/members, friends, informal supports, and health care and social services providers. The following principles are given as a guide to the case management approach to long-term care:

A. Social, environmental, service, and support needs are evaluated.
B. An individualized SCP is developed and written as needed and details all services that are provided. The CM is to coordinate the delivery of care, eliminate fragmentation of services, and assure appropriate use of resources.
C. The SCP includes both formal and informal (if available) services that assist the client/member to achieve optimum function.
D. The CM proactively identifies problems and coordinates services that provide appropriate high quality care to meet the individualized and often complex needs of the client/member.

Assessment: Assessment is an essential function of the case management process. It is an organized multidimensional process by which the CM collects and analyzes in-depth information about the client/member's environment, socialization activities, and services and social support received.

A comprehensive assessment may include a review of the following:

A. Need for nursing care
B. Need for social services
C. Physical, social and mental functioning status
D. Home environment and informal supports, if available
E. Potential risks to health and welfare
F. Identified problems/risks

Care Planning: Care planning is the process by which the CM develops a client/member-centered, evidence-based interdisciplinary SCP and Spending Plan based on the individuals needs and assessments. The SCP must detail all services the client/member is receiving.

Case Review: The CM is responsible for working with the client/member to ensure that services are being provided as described in the SCP.

Specific activities a client/member may request their CM perform to assure that needs are being met include:

A. Assure financial eligibility remains current.
B. Assure safety and welfare of the client/member.
C. Address changing client/member needs as reported by client/member and/ or representative, staff, or informal supports.
D. Address changing needs determined by client/member contact.
E. Refer and procure any additional services the client/member may need, such as hospice and home health.
F. Annually, or more often as necessary, coordinate with the client/member and all current service providers to review and revise the SCP.
G. Submit the updated SCP to all applicable service providers that are providing services to the client/member.
H. Submit Medical Necessity Evaluation Request

Advocacy: As an advocate, the CM supports the client/member in meeting goals and ensures that those involved in caring for the client/member understand the client/member's individualized needs. The CM ensures that client/member's representative's wishes and preferences are reflected in the development of the SCP by working directly with the client/member representative and all service providers. Case management advocacy refers to the actions undertaken on behalf of the client/member in order to ensure continuity of services, system flexibility, integrated services, proper utilization of facilities and resources, and accessibility to services. It also assures that the client/member's legal and human rights are protected.

****excerpt taken from the WV Aged and Disabled Medicaid Waiver Manual. Thru this stated funded program the clients are referred to as members. To find out if you are eligible, please contact us at Harris Community Care, Inc.

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Romney Location

Hampshire, Hardy & Mineral 500 E. Main Street Romney, WV 26757 Local: 304-822-8210 Toll Free: 877-385-8815 Email: Romney Office

Martinsburg Location

Berkeley, Morgan & Jefferson 709 W. Burke Street Martinsburg, WV 25401 Local: 304-263-7764 Toll Free: 877-513-7976 Email: Martinsburg Office
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