Section 686.1025  Provisional Case Manager

a)         There shall be two levels of case management staff: Provisional Case Manager and  Case Manager.  A Provisional Case Manager is one who has not achieved a competency score of 98% or greater on the  case reviews done by the Home Services Program (HSP) administrative staff per Section 686.1030(d). Assessments, service plans and reassessments completed by a Case Manager may be implemented without consultation with the HSP administrative staff.  Provisional Case Managers shall submit all developed plans to HSP for approval. Approval of the plan will be based on a review to determine that: the DON assessment on which the plan is developed is complete and accurate; the plan meets the needs identified by the assessment; and the plan is cost effective compared with comparable institutional care.

b)         All Provisional Case Managers will work toward meeting Case Manager standards within six months after receiving the HSP Case Manager Training.  Case Manager status will be granted when six case file reviews attain a competency score of 98-100% using the review process described in this subsection (b).

1)         The HSP administrative staff will review three case files within three months from the end date of the Case Manager Training.  The Case Manager will be present and have the Case Manager Training Manual.

2)         The HSP staff will review each case using the HSP case file review quality assurance form.

3)         Using the Case Manager Training Manual, HSP staff will discuss each deficiency with the Case Manager.

4)         A corrective action plan will be developed by HSP staff for the Case Manager to resolve all deficiencies in the case file.

5)         The Case Manager will implement the corrective action plan and complete all items prior to the next review of the case files.

6)         HSP staff will review all files noted in the corrective action plan for compliance with case management practices.

7)         The above process will continue until the cases reviewed for the Case Manager meet a 98-100% compliance score on six case file reviews.

c)         Return to Provisional Status

1)         A Case Manager shall return to provisional status when any of the following events occur:

A)        A review of files, per this Section, results in a score of 89% or less; or

B)        Within the last year, HSP staff have made five requests for materials that were not submitted on time.

2)         Prior to the initiation of action to return a Case Manager to provisional status, the Case Manager will be sent a letter outlining deficiencies and shortcomings. The Case Manager will have 10 days to respond.  The Case Manager will be returned to provisional status unless the Case Manager can prove the Department is incorrect.

(Source:  Amended at 38 Ill. Reg. 16978, effective July 25, 2014)