Welcome to the page for Case Managers. You will find all of the forms and documents you need to complete the IPC. New training handouts and other information can also be found on this page.
Link to Provider Support Call Notes – Provider Support Call Notes 2014 to Current
Case Manager Plan, Monitoring, and Billing Forms
- Home Visit and Service Observation Signature Form Posted 1-10-2017
- Case Management Guidance for Billing and Documentation Posted 12-09-2014
- Community Integration Schedule Form Posted 10-27-2014
- Case Management 15 Minute Unit Tracking Form Posted 10-21-2014
- Case Management 15 Minute Unit Tracking Form Sample Posted 10-21-2014
- Third Party Liability Form Word Posted 4-23-2015 · Third Party Liability Form PDF Posted 4-23-2015
- Behavioral Support Service Sample Form Posted 4-2-2014
- Behavioral Support Service Fillable Form Posted 4-2-2014
- Crisis Intervention Service Request Form Posted 4-2-2014
- Transportation Mileage Log Posted 4-2-2014
- Case Management Selection Form Revised 5-2017 Word
- Case Management Selection Form Revised 5-2017 Word Revised 5-2017 PDF
- Case Management Monthly Review Form (effective 7-1-2012) Case Management Quarterly – Effective September 2012, this form submitted electronically in Electronic Medicaid Waiver System (EMWS)
- Habilitation Support Form (effective August 2012)
Team Signature and Verification form DOC (Revised 2-2016) PDF Form
Revised Participant/Guardian Verification Form – used in EMWS last step for submitting IPC
- Planning Workbook for IPC
- “About Me” worksheet (Revised September 2012)
- Functional Analysis (Assessment) – sample (Template is sample that can be used to explore the reasons behaviors are occurring and can be used to develop Positive Behavior Support Plan.)
- Medication Assistance Record
- Medication Consent Form Revised 9-2017
- “My Medical Services” worksheet
- Participant Specific Training form
- Positive Behavior Support Plan– sample (Template is sample to guide in building a Positive Behavior Support Plan. Other versions are acceptable provided the components of the IPC align with Chapter 45 of Wyo Medicaid Rules.)
- Request for Goods and Services for Self Directed Care Process Flow
- Request for Goods and Services Form
- Supervision Level and/or Intervention Request (Use this form if requesting a higher or lower support tier in Residential or Day Habilitation or requesting intervention units)
Case Management FAQ’s
Q: Are the employers also responsible to get the documentation to the case manager?
A: The team can decide how to accomplish this task, with the employer understanding that they have a role in getting it to the case manager if that is what is decided. Self-directed services and teams get some flexibility on how they want to set these processes up, based upon how it can work to be successful for the participant. Methods may include sending documentation electronically, receiving it during home visits, sending it in the mail, etc.
Q: What if they don’t (the employers)? Do we send them a non-compliance for not receiving the paperwork (and how does that work for a relationship with your participant?)
A: Yes, if they are not complying then you can send them a non-compliance form and communicate that non-compliance can impact their ability to continue self-directing services. If the self-directed services are not carried out in compliance with the waiver requirements, the Division can involuntarily terminate the participant from self-directing. But we want the team to regroup and try to overcome any issues in a few ways before we get to the step of not allowing a person to self-direct.
Q: As a case manager, I have some questions on how this paperwork with self-directed employees is supposed to work. If the parents (employers) are tracking work hours and approving them, are they not responsible to keep their employees hours?
A: Yes, they need to keep track of the hours. The support broker’s role is to help them learn how to do this and do it with them for the first year. The requirements of the case manager having documentation of services provided ready for review by the 10th business day of the month has not changed. The case manager’s role is to ensure the hours are tracked and that documentation for services provided is collected. The employer, support broker, employee and case manager should decide together how the documentation and timesheets will work and be compiled, as needed. To add flexibility, this documentation can be reviewed electronically via electronic timecards and e-mail summary of progress of objectives, for example.
Q: Is it the employer’s responsibility to write the goals for appropriate services such as supported living? Does anyone need to approve these goals? Who is responsible to track progress on the goals and get the documentation to the case manager? Is it enough for me as the case manager to check the time sheets from PPL for self-directed services or do I need other documentation?
A: The team, including the support broker, Case manager, Employer and Employees still should work together to identify goals. The Support Broker and the Employer should write them out, though. The team should agree to the goals being worked on through supports and services. The Employer, Support Broker, and Employee should collaborate on how the progress will be measured, tracked, and reported monthly to case managers. The “documentation” may be timesheets with summaries, a separate summary, paper schedules and task analysis sheets, electronic journaling or logging, etc. The team should be discussing how it will be given to the case manager or if the case manager will receive a copy during their monthly home visit. Checking timesheets through PPL may be enough if it is giving you the information you need to do the appropriate monitoring and tracking progress as required on a monthly and/quarterly basis.
Q: What if a case manager notices a family self-directing is hiring their own family to work for a person and now they probably won’t even be leaving their home now… What can the case manager do or say? A natural support turning into a paid support doesn’t seem to be the right answer.
A: A main part of self-directing in the beginning is role of the Support Broker to work with the participant/family to figure out what is important to and important for the person and identify the circle of supports, including both paid and non-paid supports. The circle is supposed to help the person meet their needs and goals and honor what’s important to them. If non-paid supports become paid supports because the participant prefers those people assisting him/her as opposed to outside staff, then hiring them may make the most sense. But if the people hired are not supporting the person according to the plan of care, where preferences and community integration activities are listed, then the case manager has to monitor and follow up on that situation as you would in traditional services.
Another control in place is that the IBA is not changing for the person, it still needs to be used to fill in the gaps for services not fulfilled by a person’s natural supports. If the support broker, case manager and team are meeting to discuss the support and services needed to meet the person’s needs and wants, before modifying the plan, then that process should provide some quality assurance that the waiver funds are being allocated and utilized appropriately.
If there are concerns with the person’s needs not being met with current services and supports, the case manager’s role would be to work with the support broker to address the issue with the participant & family. When the support broker is no longer involved, down the road, the case manager works directly with the family to ensure the plan of care and waiver funding is being utilized to meet the person’s assessed needs and preferences…or work with the Division so we can become involved in the situation to do some re-education as needed. If the support broker needs to have consultation on how to help in this situation, we can work with the support broker as well.
Q: What is the case manager’s role in the process of adding self-direction?
A: The case manager will need to help the participant or family find a support broker. The plan needs modified to add the Support Broker to it. Then, together with the support broker, the team shall identify services being requested and the total dollar amount of services that they will be self-directing. The case manager shall allocate the funds for self-directed services to the PPL web portal, if the person is using PPL (Fiscal/Employer Agent). The services chosen shall have justification for the need for the service in the plan of care.
Q: For case managers who are doing their first plan of care with self-direction, what forms and info are necessary?
A: The new preapproval form, services available page, and the appropriate service forms if the service is unpaid caregiver training and/or goods and services. You cannot add self-direction to a plan without adding a Support Broker to the plan first.
Q: When can a participant on the Child DD Waiver apply for the Adult DD Waiver?
A: You can apply 6 months before the child’s 21st birthday. Contact your local Participant Support Specialist for an Adult Waiver application.
Case Management Documentation Requirements
Q: Beginning July 1, 2010, will case management require 2 hours of documentation?
A: Yes. Billable categories include the following: Plan of care development, Monitoring IPC, Participant specific training & retraining, Face to face meetings (including required monthly home visits), Advocacy & referral, Crisis Intervention, and Coordination of natural supports.
Q: Can the 2 hours include time that support staff to the case manager spend doing administrative paperwork or data collection for a case manager?
A: No, the 2 hours must be for billable activities specific to duties that the case manager is performing. Even though other staff may be assisting with some duties, it is the case manager’s role to monitor the services that are being provided on the plan of care, review service utilization, conduct the home visit, and provide follow-up to any issues or concerns that have been brought up including health and safety, just to mention a few. The administrative overhead figured into the case management monthly unit assumes support staff duties.
Q: Can the 2 hours include time spent talking with the Division?
A: Maybe, if the call is participant specific and fits one of the categories of billable case management, this time could be included in billable time. For instance, if you are talked with a Specialist about changes needed in the plan of care, that time could be considered under Plan Development.
Q: Is there training on filling out the CM monthly/quarterly forms correctly?
A: Your local Provider Support Specialist can review the forms with you if you have questions or have been told that you are filling them out incorrectly.
Q: Can home visit occur if during school hours but the child is home?
A: The requirements are that the child must be present, there are no other time restraints, per the case management definition
Q: Is time and phone contact with the guardian still billable by the case manager?
A: Yes, these contact times are billable as long as it meets one of the participant specific categories.
Q: Will all contacts with providers be part of billable case management documentation?
A: Participant specific training, plan development and follow up is billable. A revised monthly case management form with the billable categories on it is on the forms and documents page of our website.
Individually Budgeted Amount (IBA)
Q: Will a parent be able to request additional services during their child’s current plan year?
A: The Division will review requests on an individual basis and base requests for adjustments to IBAs upon assessed needs, the health and safety of the participant. Supporting documentation for services requested in the current plan is needed and past plans of care may be reviewed for documentation of service or support needs.
Q: Where did a child participant’s IBA funds go since they were cut so drastically?
A: Waiver funds stay in the Division’s budget for funding services for waiver participants, emergencies, and children transitioning to the adult waiver. The Division evaluates the overall waiver budget and individual budgets regularly to provide fair and equitable budgets and services across the waivers.
Q: Weren’t the funds that were in the IBA to be available when needed? In having a child with a disability, parents are not sure what will come up and what the child will need from one month to another?
A: The participant’s team should use the IBA to plan for waiver services for a full year. The case manager and family’s role is to allocate and monitor the use of those services month to month. The funding model in FY 2011 for all 3 waivers is historical units times posted rates less one-time costs.
The services on the previous plan year was used to determine the current IBA. If that IBA is no longer sufficient to meet the child’s needs, a request for an IBA adjustment can be made to the Division that lists the services needed, the reason why they are needed, and an explanation as to why the services were not needed in the past plan. These requests may be referred to the ECC for review.
Q. How were people notified that children’s IBAs would be lowered?
A: All providers were notified of these changes in a memo dated May 12, 2010. All families were notified of the changes in a letter dated May 10, 2010. As long as we have an updated address for them, they should have received it. These letters were not sent certified, however, so we can’t prove that someone received a letter. When a case manager is notified of an IBA change, they are also responsible for notifying families.
Q: How does the Division adjust IBAs for kids who had their budget drastically reduced with the new IBA formula?
A: The Division shall review the needed services for the child by request and review the information in the plan of care to determine the adjusted IBA if approved.
Q: Are the Caps on services “Hard Caps” or can they be exceeded?
A: The cap for a service is what is stated in the “scope and Limitations” section of the service definition. Special requests to exceed it shall go to ECC if the IBA will also be exceeded. Requests that do not exceed the IBA can be reviewed by the Participant Support Manager and a policy exception may be made.
Q: What do I do if I feel the interim IBA or FY2011 IBA is not correct?
A: Remember the funding model is historical plan of care units times (x) the posted rate minus (–) one-time costs. All interim IBAs are projected based on the number of months remaining on the plan. We realize that all services are not equally allocated through the plan year. If you have concerns, please submit those in writing to the Participant Support Specialist. We have a process to review these internally to make necessary adjustments.
Q: What do I do if the family has not needed many services in the past and the IBA reflects this, but the family is concerned they will need services in the future?
A: As stated before… funding model, for all three waivers, is historical plan of care units times (x) the posted rate minus (–) one-time costs. If a family historically has not included services in the plan of care, that IBA will be adjusted. If the participant’s team identify that the budget allotted does not meet the services and supports needed in the developed plan of care, then the participant may request additional funding, subject to approval from the DD Division.
Case Manager Handouts
Case Management vs. Support Brokerage Responsibilities
Case Management Conflict Free Model
- New ECC Checklist – Posted 5.23.2017
- New ECC Request – Posted 5.23.2017
- New Out of Home Placement Request – Posted 5.23.2017
- New ECC Decision Form – Posted 5.23.2017
- Bulletin Regarding ECC/CRT Merge – Posted 5.23.2017
- ECC CRT merge FAQ’s – Posted 6.13.2017
New Policies and Procedures to come soon!
- IBA Adjustment and revised ECC Policy and Procedures (memo 10-14-2010)
Electronic Medicaid Waiver System (EMWS)
HCBS and the Case Manager Role
What is the role of the Case Manager and HCBS (PowerPoint Section from CM Training 11/2016)
- IBA Methodology with Scenarios Revised 6-24-2016
A Guide to Independent and Supported Living
*The Independent and Supported Living Guide was developed to assist individuals and teams make decisions and set attainable goals regarding Independent Living options. The Guide and the included Skill Building Assessment Tool are designed to be used together to facilitate a successful transition to independent living. A successful transition can take months even years. It is important to consider the individual’s strengths and support needs throughout the process.
This is a DRAFT version of the Guide. We would appreciate any feedback you would like to offer regarding the use of this Guide to be incorporated into the final version. Please direct your questions, comments and suggestions to:
**NEW REVISED IPC eGuide- Rev. 7/2017 (Revisions will occur to guide over the course of the next several months as processes and new rules are changed/added)
IPC Documents and Related Materials
- IPC Planning Guide
- IIndividualized Plan of Care Documents
- Link to current Service Definitions and Fee schedules
- Individualized Plan of Care Documents
- Non Compliance Form
- Out-of-Home Placement RequestPDF
- Out-of-Home Placement Request Word version Word Doc
- Suppport Broker Opt Out Request Form– with Case Manager assessment (posted 3-18-2011)
- Support Broker Opt Out Process Flow
- Relative Disclosure Form
- Reconsideration Requests Process Flow
- Request for Goods and Services for Self Directed Care Process FlowRequest for Goods and Services Form
- Example of Completed Objective & Schedule
- Employment Objectives
- Habilitation Objectives (For Supported Living, Res & Day Hab, Special Family Hab Home, Child Hab Srvs)
- Personal Care Schedule
- Psychological Requirements
- Residential Habilitation Training Schedule
- Respite Schedule
- Special Family Hab Home Schedule
- Sample Day Habilitation Schedule (With behavior plan and objective data collection components)
- Sample Intervention Hours Schedule
- Sample Residential Habilitation Schedule
- Sample Task Analysis Sheet
- Supervision Flexibility Form Posted 2-27-14
Request Goods and Services Through Self-Direction
Rights and Restrictions Information
What are Rights Restrictions? – posted 1/22/2016
What Does CMS Say About Rights Restrictions? – posted 1/22/2016
Rights Restriction Process Flow Chart – posted 1/22/2016
Clarification on HCBS Standards and FAQ’s – reposted 12-3-2015
Rights, Responsibilities, and Restrictions Guide
(Case Managers can use this tool to review the Participant and guardian’s rights and responsibilities at least every six months or more as needed.)
Sample Objectives and Schedules
Supervision Flexibility Form
· Supervision Flexibility Form Posted 2-27-14
Note: Providers who are implementing staffing flexibility must discuss the changes in staffing with the participant or guardian and case manager. This form must be signed by all parties and uploaded to EMWS in the person’s document library by June 1, 2014.
For services included on a Participant’s IPC, a supplemental form is completed by the provider and sent to the Case Manager before the IPC is submitted to the Division. Objectives are required for habilitation services, but do not need to be sent to the Division with the IPC.
- Team Meeting Checklist revised 11-2016