Regulation .07 Limitations.
Regulation .07 Limitations.LinkCopy Citation
A.
Mental health case management services are advisory in nature.
B.
A restriction may not be placed on a qualified recipient's option to receive mental health case management services.
C.
Mental health case management services do not restrict or otherwise affect:
(1)
Eligibility for Title XIX benefits or other available benefits or programs, except as limited by §E of this regulation;
(2)
The freedom of a participant to select from all available services for which the participant is found to be eligible; or
(3)
A participant’s free choice among qualified providers.
D.
Mental health case management providers may not bill the Program for:
(1)
The direct delivery of an underlying medical, educational, social, or other service to which a participant has been referred;
(2)
Activities integral to the administration of foster care programs;
(3)
Activities not consistent with the definition of case management services under Section 6052 of the federal Deficit Reduction Act of 2005 (P.L. 109-171);
(4)
Activities for which third parties are liable to pay; or
(5)
Activities delivered as part of institutional discharge planning.
E.
Reimbursement may not be made for mental health case management services if the participant is receiving a comparable case management service under another Program authority.
F.
A participant's case manager may not be the participant's family member or a direct service provider for the participant.