Sec.17a-301-4. The coordination, assessment and monitoring process

(a) Screening. Referrals shall be reviewed within 5 work days after they are received, using a form approved by the Commissioner on Aging.

(1) The CAM agency shall either schedule an assessment, place the applicant on a waiting list if available funding or workload do not permit immediate assessment, or reject the applicant as inappropriate for the program.

(2) In the event that an assessment is not scheduled, the individual shall be notified of the disposition of the application (waiting list or rejection) and the reasons for the action taken within 72 hours of screening by the CAM agency. The individual shall be referred to other agencies for assistance if appropriate.

(b) Assessment.

(1) An assessment is scheduled and shall be performed within seven days, if there is available funding and staff or when an individual's name has been reached on the waiting list.

(2) The assessment will be performed using the instrument specified by the Department to assess the functional, psychological, cognitive, social, environmental, financial and health status of the individual, and the extent to which informal supporters are available or active in the individual's care. The assessment shall be performed by a case manager.

(3) The CAM agency shall use its best efforts to obtain relevant information from any other health or social service agencies or professionals which have provided services or care to the individual. The CAM agency shall first obtain signed releases from the individual or responsible party.

(4) Upon completion of the assessment, the CAM agency shall discuss with the individual, or responsible party, the findings of the agency and send a written notice to the individual or responsible party making a referral. The notice shall state:

(A) Whether the individual is eligible for admission to the Program; or

(B) The reason for a determination of ineligibility if applicable;

(C) In the event of a determination of ineligibility, notice of appeal rights, including the procedure to be used and any deadlines and the name and telephone number of a person to contact for more information on the appeals process.

(c) Individualized Plan of Care.

(1) Upon admission into the Program, an individualized plan of care shall be developed for each client by the case manager assigned to the client. The plan of care shall include all services the client needs to safely remain in the community. The plan of care includes services to be provided by informal supporters and any services to be funded by third party payers.

(2) The case manager shall involve the client and any key informal supporters identified during the assessment in developing the plan of care. The client, or other responsible party, must indicate approval of the plan of care prior to implementation.

(3) The case manager shall determine which services will meet the needs of the client. When more than one type of service will equally meet the identified needs, the case manager shall choose the type with the lower cost. When more than one person or agency provides a necessary service of equal quality, the case manager shall choose the one offering the lower cost.

(4) The case manager shall obtain funding for necessary services from all third party funding sources available. Program funds will be used only when no other funding source is available. In no event shall the cost to the Department exceed 60 percent of the annualized weighed average daily rate for skilled and intermediate nursing care in Connecticut in effect on January 1st, as determined by the Commissioner of Income Maintenance.

(5) In the event that a person other than a legally liable relative agrees to assume responsibility for the client's share of the costs, amounts paid by such person shall not be counted as income to the client for the purposes of determining eligibility or required contributions.

(d) Individualized Plan of Care Implementation.

(1) Services other than assessment and case management will be obtained from community service providers.

(2) Services paid for with Program funds will be procured through subcontracts and individual service orders.

(3) The CAM agency shall not use Department funds to purchase community services from itself or any related parties.

(4) Services paid for through other funding sources will be arranged by the case manager, who will assist the client in completing applications and any necessary intake processes.

(e) Monitoring and Case Management.

(1) Clients who require ongoing case management shall be monitored by the case manager as follows:

(A) Reviewing the care plan at least every 60 days,

(B) Making a home visit to the client at least every six months to determine the appropriateness of the service plan and to assess changes in the client's condition. The case manager shall conduct a formal reassessment of the client's health, functional and financial status and service needs every twelve (12) months,

(C) monitoring service delivery, including reviewing provider reports and records of service delivery, and

(D) responding to changes in client needs as they occur, making appropriate changes in the type, frequency, cost or provider of services needed for the client to remain in the community.

(E) In accordance with any additional requirements established under the agency's licensure.

(2) Ongoing monitoring by a case manager may be suspended for a client who, at the time of the sixty (60) day care plan review, meets the following criteria:

(A) The client's functional and cognitive status have been determined to be stable (this can include the presence of chronic health problems if the conditions are under control and do not require intervention by a case manager), and

(B) No changes in the total plan of care are anticipated during the following sixty (60) days with the exception of changes in the particular individuals who are providing care or scheduled terminations of short-term services, and

(C) The client or a legal representative has signed a consent form accepting the suspension of monitoring services and indicating that either the client or a responsible party will regularly monitor the client's needs and promptly report changes therein to the case manager.

(3) When ongoing monitoring by a case manager has been suspended, the client may continue to receive other home care services through this program. The department shall require renewals of service orders at least every six months and annual redeterminations of eligibility in order to continue services. If the client's condition becomes unstable and the client continues to reside in the community, the CAM agency shall reinstate monitoring services within seven days.

(f) Discharge.

(1) A client must be discharged from the Program under any of the following conditions:

(A) The client has been institutionalized in an acute or long term care facility for a period exceeding 90 days; or

(B) It has been determined that a client who has been institutionalized in an acute or long term care facility for less than 90 days will not be able to return to the community within that period of time; or

(C) The client is no longer eligible for the program (see Sec. 17a-301-3a); or

(D) The client's condition improves to the point where he or she is no longer in need of case management or other services funded by the department; or

(E) The client is admitted to the Nursing Home Preadmission Screening and Community Based Services Program or is enrolled in the Protective Services for the Elderly Program for 90 days or more; or

(F) The client or family fails to make mandatory co-payments; provided clients will not be discharged if: (1) a provider agrees to absorb the client's share of costs, or (2) if a charitable, religious or other non-state funding source agrees to make co-payments on the client's behalf, or (3) the client qualifies for an exception to the co-payment requirement as determined under Section 17a-301-3 of these regulations.

(G) The client takes up residence in another state.

(H) The client voluntarily withdraws from the program or refuses all services.

(2) The CAM agency will develop a discharge plan which ensures the continued well being of the client to the maximum extent possible.

(3) When a client is to be discharged, the client or responsible party will be given at least ten (10) days notice and will be notified of the reason for discharge and the client's right to appeal. The reason for discharge will be entered into the client's file with all relevant documentation.

(4) CAM agencies will have written discharge policies and will notify the client or responsible party of these policies at the time of admission.

(5) Nothing in these regulations shall be deemed to require the CAM agency or any provider to provide services if it has determined that continued participation would constitute an unacceptable risk to the safety the client or others.

(Effective June 2, 1992)