Community Based Alternatives Provider Manual

Section 3000

This section is a general overview of case manager actions that effect all types of Community Based Alternatives (CBA) providers, such as terminating services to an approved participant. In the respective sections of this manual can be found the case manager actions that pertain only to that kind of provider. The specific roles and responsibilities of the Department of Aging and Disability Services (DADS) case manager pertaining to the CBA program are not found in the Community Based Alternatives Provider Manual. They are found in the Case Manager Community Based Alternatives Handbook, that can be accessed at www.dads.state.tx.us/news_info/publications/handbooks/#handbooks (Internet address).

Case Management Overview
Table of Contents

3100
Intake/Screening
3200
CBA Enrollment Process
3210
Finalizing Enrollment
3220
Client Eligibility Criteria
3230
Interdisciplinary Team
3240
Selection of Providers
3250
Coordination of ISP with HCSSA, AFC and AL Providers
3260
Coordination of Termination of CCAD Services Upon CBA Enrollment
3270
Verbal Negotiation with CBA Providers Regarding Service Initiation Date for Applicants
3280
Provider Change Procedures
3300
Denial or Suspension of Services to Current Participants
3310
Community Based Alternatives (CBA) Definitions
3320
Denials, Reductions, Sanctions, Suspensions and Terminations
3321
Extension of Suspension
3322
Reinstating CBA Services After Being Institutionalized
3323
Medical Necessity Denials
3324
Loss of Medicaid
3325
Refusal to Serve Participant
3326
Refusal to Comply with Mandatory Program Requirements and Service Delivery Provisions
3327
Failure to Pay Copayment or Room and Board
3328
Denial Due to Hazardous Conditions for the Service Provider's Health and Safety
3330
Circumstances Requiring Denial of Services and Medicaid Eligibility Without Advance Notice
3331
Termination Due to Death of Participant
3332
Other Mandatory Terminations Without Advance Notice
3340
Circumstances Which May Result in Denial of Services and Require Advance Notice
3341
Demonstrated Pattern of Abuse or Discrimination
3342
Denial Due to Verbal Abuse, Harassment, or Discrimination
3350
Crisis Intervention Requiring Immediate Suspension or Reduction of Services Without Advance Notice
3351
Suspension Procedures Pertaining to Imminent Danger
3352
Administrative Payment During Suspension
3353
Crisis Interventions
3354
Denial Without Advance Notice
3360
Immediate Suspension with Advance Notice
3370
Sanctions
3380
Reinstatement of Services Terminated for Threats to Health or Safety
3390
Reinstatement of Suspended Services
3400
General Information Regarding Approvals/Denials
3500
General Information Regarding Appeals
3510
Continuation of CBA Services During Appeal
3600
Utilization Review
3700
Reassessment
3710
Annual Reenrollment Activities
3720
Annual Medical Necessity Evaluation and Home Health Assessment
3730
Annual Update of the ISP
3740
Reassessment Copayment Procedures