Services | Prestige Case Management Services

Our Services

Prestige Case Management Services follows the philosophy of Community Long Term Care guidelines in South Carolina. Our role is to optimize the participant’s (Children & Adults) life choices and rights, to minimize threats to the participant’s safety and health, and to provide a mechanism for managing home and community based alternatives to institutional care. The services allows for a range of options based on choice, role, and responsibility in the decision-making process for persons who want to direct their own home and community based long term care services through the assistance of a case manager, financial management service, and a budget controlled by them for the services identified as needed in their Service Plan.

Service Counseling

Service counseling involves objectively consulting, discussing, advising, and listening. The Prestige Case Manager is in a position to confer with the participant and/or primary contact or other permitted caregiver supports concerning needs and to provide information that will assist them in making sound long term care decisions. The service counseling process includes educating the participant and/or primary contact or other permitted caregiver supports with the long term care options available to them and ensuring the participant's right to be involved in planning his/her care. The various service options and their expected outcomes should be clearly explored with the participant and/or primary contact and other permitted caregiver supports.

Service Planning

Service planning is the active, on-going process of working together with the participant and/or primary contact or other permitted caregiver supports to assure the efficient provision of services. The Prestige Case Manager shall constantly strive to empower the participant to become as independent as possible in advocating for his/her self and coordinating his/her own care. In partnership with the team member and other multi-disciplinary team members, the Prestige Case Manager should work toward developing an agreement with the participant and/or primary contact or other permitted caregiver supports regarding the problems that exist, the goals or outcomes to be reached, and the services and interventions to be explored to reach the goals.

Service Coordination

Service coordination is a vital component of case management and must be documented. The Prestige Case Manager works together with the participant, primary contact and/or other permitted caregiver supports and other agencies involved in the participant's care to ensure services:

• are appropriate for the participant's needs; meet acceptable quality standards; are not duplicated; are cost effective alternatives
• maximize the utilization of available resources;
• are provided by other agencies in accordance with maintenance of effort agreements (Refer to Section 07.21); and,
• augment, not replace, the participant's informal support system.

Monitoring

The Prestige Case Manager monitors the plan for each waiver participant at least monthly. Monitoring should be accomplished through contacts with the
participant and / or primary contact. If the Prestige Case Manager is unable to contact the participant and/or primary contact after several attempts on different days/times, approval may be obtained from the Director of Prestige Case Management Services to make the required contact with a knowledgeable other.

Assessment

The Assessment is used to re-determine a waiver participant's long term care needs. Information obtained during the re-evaluation process should be adequate for the Prestige Case Manager to re-determine the participant's level of care, service planning, and service needs. It is the Prestige Case Manager’s responsibility to ensure the assessment is completed accurately and thoroughly before a level of care is determined.

Re-Evaluation

The Prestige Case Manager will complete re-evaluations for all waiver participants. A re-evaluation visit with a participant receiving case management is scheduled for completion every 365 days. The 365 day cycle begins with the last assessment completed by the Nurse Consultant prior to waiver enrollment. Subsequent re-evaluations will be scheduled 365 days from the date the last assessment was completed. Re-evaluations, levels of care, and service plans must be completed by the due date. Re-evaluations that are due by/on the 7th day of each month may be completed in the month prior to the due date. When the re-evaluation is conducted on a date other than the scheduled date, the 365-day cycle will be adjusted and subsequent re-evaluations will be scheduled 365 days from the date the last assessment was completed.

The HIPAA Privacy Rule
The HIPAA Privacy Rule establishes national standards to protect individuals' medical records and other individually identifiable health information (collectively defined as “protected health information”) and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically. The Rule requires appropriate safeguards to protect the privacy of protected health information and sets limits and conditions on the uses and disclosures that may be made of such information without an individual’s authorization. The Rule also gives individuals rights over their protected health information, including rights to examine and obtain a copy of their health records, to direct a covered entity to transmit to a third party an electronic copy of their protected health information in an electronic health record, and to request corrections.

The Privacy Rule is located at 45 CFR Part 160 and Subparts A and E of Part 164.