Section 441.90.3. Determination of need for service.

         90.3(1) Authorization required. Rescinded IAB 7/15/09, effective 7/1/09.

         90.3(2) Need for service. Assessment of the need for targeted case management is required at least annually as a condition of payment under the medical assistance program. The case management provider shall determine the initial and ongoing need for service based on diagnostic reports, documentation of provision of services, and information supplied by the member and other appropriate sources. The evidence shall be documented in the member's file and shall demonstrate that all of the following criteria are met:

            a.              The member has a need for targeted case management to manage needed medical, social, educational, housing, transportation, vocational, and other services for the benefit of the member.

            b.               The member has functional limitations and lacks the ability to independently access and sustain involvement in necessary services.

            c.               The member is not receiving other paid benefits under the medical assistance program or under a Medicaid managed health care plan that serve the same purpose as targeted case management.

         90.3(3) Managed health care. Rescinded IAB 1/6/16, effective 1/1/16.

         90.3(4) Transition authorization. Rescinded IAB 7/15/09, effective 7/1/09.

[ARC 7957B, IAB 7/15/09, effective 7/1/09; ARC 2361C, IAB 1/6/16, effective 1/1/16]