Case management shall be central to the operation of the interdisciplinary treatment team and shall be based on the level of care needed by the primary consumer. Case managers for consumers from the four groups shall have special skills in advocacy, access of community-based services and systems, and interagency coordination. Case management shall also be consumer- and family-driven. Case managers shall be accountable for the cost and appropriateness of the services they coordinate. The Managed Care Plan shall maintain responsibility for the successful and appropriate implementation of the Case Management Plan and provision of adequate administrative resources and endorsement.
- Case managers working with consumers from the four groups and their families shall demonstrate their level of cultural competence as part of their privileging and credentialing standards within the Plan.
- Case managers shall be knowledgeable about the four groups and their subgroups, their resources, and natural supports.
- Case managers shall have access to flexible funds for the provision of wrap-around services.
- Case management shall be continuous and proportional to the degree of the consumer’s need, level of impairment, and person/family resilience. The case manager shall act as a single point of contact in the Plan and have support for coordinating service across all levels of the system of care.
- The Health Plan shall ensure and enforce that caseloads for case managers are consistent with industry standards, accounting for severity of consumer impairment/case mix and associated cultural stressors. It shall be recognized that case or care management for patients who have limited English proficiency and/or have a broadly defined "client-defined family" and/or social network (e.g., clan leader) relevant to their care, may require additional time for planning and coordination.
- Practice privileges shall be afforded to case managers across the entire system of care including settings such as inpatient facilities.
- Each member of the consumer’s Treatment Plan shall have responsibility for developing progress notes and reports as appropriate.
- The primary provider/case manager shall periodically review the consumer’s progress in accordance with the Treatment Plan. Changes in the Treatment Plan's components shall be reviewed with the consumer before implementation.
Recommended Performance Indicators
- Cultural competence requirements commensurate with level of responsibility, including culturally competent supervision of case managers who serve consumers from the four groups.
- Cultural competence training for all case managers as part of a credentialing process.
- Community resources and natural supports included in all care plans.
- Use of flexible funding for consumers from the four groups, comparable to others.
- Sufficient numbers of case managers to support caseload and workload standards for consumers from the four groups.
- Consumer and case manager involvement in treatment decisions across all levels of care.
- Consumer and family satisfaction with services selection and coordination.
Benchmark: 90% satisfaction.
- Reduction in utilization of and lengths of stay in more restrictive levels of care.
Benchmark: Comparable to overall community and decreasing over time.
- Access to culturally competent mental health care across all levels of care within the system.
Benchmark: Comparable to overall community and increasing over time.