Person Centered Case Management

Section: Case Management Agency (CMA)
Created: 02/25/2024
Revised:
Effective: 03/01/2024

Policy

In accordance with federal, contractual, regulatory requirements, and the interests of individuals, Members, and families, Weld County CMA (WCCMA) case management functions and services shall be provided in a person-centered model of service delivery. This policy helps ensure WCCMA practices are tailored to meet the unique needs, preferences, and values of the individuals, Members, and families we serve.

Scope

This policy applies to all WCCMA staff.

Contract Section(s)

1.3: Qualification and Training Requirements

Relevant Rule(s)

8.7201.K - Case Management Agencies shall have policies and procedures that assure compliance with all federally mandated requirements for access to services: Case Management agency functions shall be provided in a person-centered model of Case Management service delivery.

Policy Statements

1. Commitment to Person-Centered Case Management
   • WCCMA commits to delivering Case Management services that respect the dignity, preferences, and values of the individuals we serve. Our services are designed to facilitate assessments and planning that empower individuals to recognize and develop their own strengths and abilities, enabling them to live an independent and fulfilling life.
2. Person-Centered Support Planning
   • We engage in a collaborative process with Members and those they choose to involve, to identify personal goals, needed services, individual choices and preferences, and appropriate service providers. This process is informed by a comprehensive assessment of the individual's needs and a thorough understanding of available community resources. Our approach ensures that individuals are fully informed of their rights and responsibilities throughout the service planning process.
3. Development and Participation in Person-Centered Support Plans
   • Support plans will be directed by the individual wherever possible, with the individual’s representative acting in a supportive role as needed. These plans, prepared by the Case Manager, will articulate the supports needed for the individual to achieve personally identified goals, grounded in respect for and valuation of individual preferences, strengths, and contributions. Individuals and/or their Legally Authorized Representatives will actively participate in the development and approval of their Person-Centered Support Plan and will be provided with a copy.
4. Inclusivity and Choice in Planning
   • Members have the right to include anyone they wish in their service and Person-Centered Support Planning process. They are entitled to support that enables them to direct this process to the greatest extent possible, helping them make informed choices and decisions. Furthermore, Members have the right to convene planning meetings at times and places that are convenient for them and to select from eligible programs and services in accordance with identified needs.
5. Transparency and Freedom from Conflicts of Interest
   • WCCMA informs Member in advance of any changes to their services and will receive services and supports free from any potential conflicts of interest with their case management or with the development of their Person-Centered Support Plan.
6. Engagement in Health and Well-being
   • WCCMA will actively engage Members and their families or caregivers in their health and well-being, ensuring that our services and interactions are characterized by responsiveness, inclusivity, and respect for the personal narratives and cultural backgrounds of those we serve. Our approach will demonstrate:
     • Responsiveness to Needs: By integrating best practices in communication and cultural responsiveness, we commit to addressing the needs of Members and their families/caregivers effectively and empathetically. Our service delivery model is built on understanding and respecting the diverse circumstances and preferences of each family unit.
     • Clear and Concise Communication: We will utilize a variety of communication tools and techniques to ensure that information is shared clearly and concisely with Members and their families. This includes, but is not limited to, written materials, digital resources, and verbal interactions, all tailored to meet the accessibility and understanding levels of our diverse community.
     • Alignment with Department’s Approach: WCCMA's Member engagement activities will be in strict alignment with the Department’s person- and family-centered approach. This involves a commitment to respecting and valuing the individual preferences, strengths, and contributions of Members and their families.

Procedure: Training and Professional Development

WCCMA is dedicated to the highest standards of service delivery, grounded in person-centered principles and practices. To fulfill this commitment, WCCMA shall meet all established training requirements, ensuring that case managers possess the necessary skills and knowledge to effectively implement our policies and meet the unique needs of those we serve.

1. Person-Centered Practice Training:
   • Case Management staff complete foundational training modules on Person-Centered Service Plan Development, Disability and Cultural Competency, and other training as required and designed by Health Care Policy and Financing (HCPF).
   • Case Management will undergo specialized training to meet competency requirements for the correct application of the forthcoming Colorado Single Assessment and Person-Centered Support Plan. Successful completion of this training is mandatory for Case Managers to perform case management tasks independently.
   • Case management staff shall participate in Department training, which will be tracked by the Department. Participation can be at the time of the presented training or, if applicable, following the training using the materials available from the Department’s website or LMS
   • Our training program includes competency-based requirements set by the Department in areas such as disability and cultural competency, person-centeredness, soft skills, and program-specific knowledge. Staff must successfully complete these competency-based training requirements before they can perform independent case management duties.
   • Staff must complete Colorado rules based, person-centered specific training on topics such as person-centered case management, person-centered support plans, person-centered assessments, HCBS Settings Rule and Rights Modifications, individual and Member rights, and accessibility.
2. Timelines and Milestones:
   • Training Deadline: All case management staff are required to receive their initial training within 120 calendar days from their hire date. This training is prerequisite to being assigned independent case management responsibilities.
   • Ongoing Training: Retraining schedules will be determined based on Department requirements, approved vendors' guidelines, or as deemed necessary by WCCMA to ensure staff remain current with evolving practices and regulations.
3. Monitoring and Evaluation:
   • Supervision: The training process for each employee is closely overseen by an assigned Case Management Supervisor. Training will be delivered using a variety of tools and resources provided by Health Care Policy and Financing (HCPF), WCCMA, and experienced Weld CMA staff, including Supervisors, Leads, and other designated personnel.
   • Feedback Loops: To ensure the effectiveness of our training program, regular feedback and evaluation sessions are integrated throughout the training process.
4. Compliance and Reporting:
   • Performance: Any performance issues that arise during the training period will be addressed following the policies and procedures of Weld County Department of Human Services (DHS). This approach ensures that all staff meet the expected standards of competence and professionalism.
   • Retraining: In cases where performance concerns are identified, Case Management staff may be required to retake training modules as directed by WCCMA or HCPF. This measure is in place to address and remediate any deficiencies, ensuring all staff meet the necessary competency standards.
   • Reporting: WCCMA Program Managers are responsible for maintaining accurate records of all case management staff, both new and existing, including their hire dates and the dates on which they completed training in the specified areas outlined in Section 1.3.6 of the Contract. These records are submitted to the Department using the designated reporting template.

Policy Review

This policy will be updated as needed based on feedback and changes to contractual and regulatory requirements.