Ch. 29, § 4. Case Management

(a) The Department may subject a client to case management if the Department determines the client requires assistance in using covered services appropriately for any reason, including: (i) The client appears unfamiliar with the Medicaid program or the delivery of services; (ii) The client has a severe medical problem; or (iii) The client is receiving high-cost services. (b) If the Department subjects a client to case management, the Department need not notify the client. (c) Case management includes the following actions: (i) Monitoring the utilization of covered services to ensure that they are medically necessary and appropriate; (ii) Conducting reviews of services while the client is at a facility; (iii) Conducting on-site reviews with clients or providers to determine whether the provided services are medically necessary and appropriate; and (iv) Taking any other action relevant to the coordination and facilitation of covered services in an efficient manner or setting consistent with the appropriate care for the client.