Legislative Gudieline 4
Comprehensive Care Centers for Eating Disorders shall provide case management services for all individuals served by the Center.
Because of the complexity of eating disorders, the multiple levels of treatment, and the length of the recovery process, Comprehensive Care Centers for Eating Disorders must provide each individual with case management services. Case management will include, at a minimum, a comprehensive multidisciplinary assessment of medical, social, psychological and other needs and a plan for appropriate services, coordinated by a designated case manager and developed in conjunction with the individual, their family (where appropriate) and the team. Case management must encompass coordination of multidisciplinary care, service linkages, and transition among levels of care and must address individuals' identified needs in the context of their personal support networks for partial hospital, inpatient, residential, and outpatient settings including a range of services in each. The case manager must ensure the coordination of these services, including those provided in community settings, within a reasonable distance of persons' homes. Case management services will include:
An accessible process must be in place for individuals and their family members and health and mental health providers to receive information and intake, and if appropriate an assessment. For any individual new to the Comprehensive Care Center for Eating Disorders, the case manager will arrange and participate in an intake and comprehensive multidisciplinary assessment of medical, social, psychological and other domains to determine the individual needs and available support systems. Periodically, comprehensive reassessments will update service needs and available support systems.
- Multi-Disciplinary Care Coordination
All individuals treated at Comprehensive Care Centers for Eating Disorders will receive coordination of care provided by multiple disciplines and service providers. This assistance includes coordination of appointments, follow-up for missed appointments, sharing of relevant information among care providers, acquisition of medical records and other clinical coordination activities.
- Service Plan Development, Implementation, Monitoring and Periodic Reassessment
Comprehensive, long-term case management in collaboration with all providers is required for all individuals treated by Comprehensive Care Centers for Eating Disorders. Assistance will be provided for those who need help accessing services including those required by these Guidelines and also housing, entitlements and other services. The case manager will provide personal assistance with finding accommodations for patients and families during treatment if needed.
- Payment Arrangements
The case manager will work with individuals and families from the time of initial intake and assessment to identify and maximize all available insurance and entitlements. Because treatment for eating disorders may be lengthy and is often not fully covered by insurance, identifying payment arrangements during the initial phase of treatment will allow the individual and their family to focus on the treatment being provided. The case manager will provide ongoing support to the individual and their family to assist them with payment arrangements, prior authorizations and other health plan requirements, insurance appeals, and accessing disability benefits, Medicaid, Family Health Plus or other forms of third party reimbursement.