SECTION 259.311. CMA Service Delivery

(a) A CMA must ensure that:

(1) a full-time case manager is assigned to provide case management to no more than 50 individuals at one time;

(2) a part-time case manager is assigned to provide case management to no more than 25 individuals at one time; and

(3) for a month in which a case manager does not meet with an individual or LAR as required by §259.79(a) of this chapter (relating to Renewal and Revision of an IPC), the case manager has an in-person or telephone contact with the individual or LAR or other persons acting on behalf of the individual, such as an advocate or family member, to provide case management.

(b) In determining the number of individuals to which a case manager will be assigned, a CMA must consider:

(1) the intensity of an individual's needs;

(2) the frequency and duration of contacts the case manager will need to make with the individual; and

(3) the amount of travel time involved in making such contacts.

(c) A CMA must have:

(1) an adequate number of case managers available to ensure the provision of case management to an individual at all times; and

(2) a written process that ensures that case managers are or can readily become familiar with individuals to whom they are not ordinarily assigned but to whom they may be required to provide case management.

(d) A CMA must ensure that a case manager participates as a member of an individual's service planning team and uses the person-centered planning process when developing or revising required documentation in accordance with this chapter and the Community Living Assistance and Support Services Provider Manual.

(e) A CMA must ensure that case management is provided to an individual in accordance with the individual's IPC.

(f) A CMA must submit an IPC to HHSC within the time periods required by §259.65 of this chapter (relating to Development of an Enrollment IPC) and §259.79(g)(2)(A) and (g)(3)(A) of this chapter to ensure that a DSA receives reimbursement for the provision of CLASS Program services and CFC services.

(g) A CMA must follow the process for requesting authorization to purchase dental treatment, as described in the Community Living Assistance and Support Services Provider Manual.

(h) If an individual may need cognitive rehabilitation therapy, a case manager must assist the individual in obtaining, in accordance with the Medicaid State Plan, a neurobehavioral or neuropsychological assessment and plan of care from a qualified professional as a non-CLASS Program service.

(i) A CMA must ensure that an individual's case manager complies with §259.205 of this chapter (relating to Residential Agreements, Requirements for Provider-Controlled Residential Settings, and Support Family Agency and Continued Family Agency Functions).

Source Note: The provisions of this §259.311 adopted to be effective January 30, 2023, 48 TexReg 362