(a) Case management means services provided to assist an eligible child and their family in gaining access to the rights and procedural safeguards under IDEA Part C, and to needed medical, social, educational, developmental, and other appropriate services. Case management includes:
  (1) coordinating the performance of evaluations and assessments;
  (2) facilitating and participating in the development, review, and evaluation of the individualized family service plan in accordance with Subchapter J of this chapter (relating to Individualized Family Service Plan (IFSP)) which is based upon:
    (A) the child's applicable history;
    (B) the parent's input;
    (C) input from others providing services and supports to the child and family; and
    (D) the results of all evaluations and assessments;
  (3) assisting families in:
    (A) identifying unmet needs;
    (B) identifying available providers of services and supports;
    (C) making appropriate referrals and facilitating application; and
    (D) assisting with initial and ongoing contact to obtain services from medical, social, and educational providers to address identified needs and achieve goals specified in the IFSP;
  (4) following up with families and providers of services and supports to assist the child with timely access to services, and discuss the status of referrals to determine if the services have met the child's identified needs, and if ongoing assistance to ensure continued access will be necessary;
  (5) monitoring and assessment of the delivery of and effectiveness of services that:
    (A) occurs at least once every six months, or more frequently as needed;
    (B) is individualized and clearly related to the needs of the child and family;
    (C) collects information from family members, service providers, and other entities and individuals who provide service or supports to the child and family to assess if:
      (i) services are being provided in accordance with the child's IFSP;
      (ii) services are adequate to meet the child's and family's needs;
      (iii) all service providers are effectively collaborating to address the child's and family's needs; and
      (iv) parents and routine caregivers are able to use the interventions being presented;
  (6) adjusting the IFSP and service arrangements if new needs, ineffectiveness, or barriers to services are identified;
  (7) assisting the parent or routine caregiver in advocating for the child;
  (8) coordinating with medical and other health providers to ensure services are effective in meeting the child's and family's needs; and
  (9) facilitating the child's transition to preschool or other appropriate services and supports.
(b) Medicaid reimbursement is available for the provision of targeted case management if the following criteria are met:
  (1) the contact occurs with the parent or routine caregiver;
  (2) the contact occurs face to face or by telephone;
  (3) the contact is of at least eight minutes in duration;
  (4) the desired outcome of the contact is of direct benefit to a child who is eligible for ECI services; and
  (5) during the contact the service coordinator performs a case management activity as described in subsection (a) of this section.
(c) Non-billable case management contacts must be documented in a child's record. These contacts occur when:
  (1) the contact is with individuals other than a parent or routine caregiver;
  (2) the desired outcome of the contact is of direct benefit to a child who is eligible for ECI services; and
  (3) during the contact the service coordinator performs a case management activity as defined in subsection (a) of this section.

Source Note: The provisions of this §350.405 adopted to be effective September 1, 2009, 34 TexReg 5575; amended to be effective September 1, 2011, 36 TexReg 5403; amended to be effective June 30, 2019, 44 TexReg 3280; transferred effective March 1, 2021, as published in the Texas Register February 5, 2021, 46 TexReg 941