(1) Case management is the planning for, arranging for, implementation of, and monitoring of the delivery of services available through the program to a person.

(2) Case management services include:

(a) developing a plan of care for a person;

(b) monitoring and managing a plan of care for a person;

(c) establishing relationships and contracting with service providers and community resources;

(d) maximizing a person’s efficient use of services and community resources such as family members, church members, and friends;

(e) facilitating interaction among people working with a person;

(f) prior authorizing the provision of all services; and

(g) managing expenditures.

(3) A case management team must consist of:

(a) a registered nurse with experience on a case management team serving persons through a program of home and community-based services for the elderly and persons with physical disabilities, or severe disabling mental illness; and

(b) a social worker with two consecutive years experience providing case management services to adults with severe disabling mental illness.

(4) The case management team must:

(a) be a legal entity contractually retained by the department to provide Medicaid funded home and community case management services to persons who are elderly or who have physical disabilities;

(b) function as directed by the department;

(c) assure that services provided to recipients are of appropriate quality and cost effective;

(d) provide case management services to no more than the number of persons specified by the department;

(e) manage expenditures within the allocated monies; and

(f) meet the department’s reporting requirements.