Case Management Program

What is the Case Management Program?

This program is a voluntary and confidential program designed for FHC members who receive mental health services. Our approach in the Case Management Program is a process of evaluation and advocacy for options and services that meet individual health needs through communication and resources available to promote quality outcomes.

What is the goal of the program?

The goal is to increase the adaptive capacities and functioning level of members, offering them tools that allow them to find a recovery process the least restrictive level of care and thus improve their quality of life as well as that of their family.

The following strategies will be used_ to achieve this goal:

1. Conduct an initial evaluation.
2. Assess drug safety.
3. Educate the member about their rights and responsibilities, the grievance and complaints process, and the right to refuse Case Management Program services.
4. Help members develop individualized recovery plan.
5. Keeps members informed about the different service options that are available for recovery.
6. Facilitate the implementation of the individualized recovery plan.
7. Maintain communication with physical health providers about members' medical history, level of functioning, services provided, and individualized recovery plan.
8. Coordinate links with different community resources, such as support groups, agencies, and programs.
9. Provides practical coordination of after-discharge services.
10. Help the member access community services.
11. Help members be functional in the roles that they have selected. The case manager includes the family and community resources in the interventions.
12. Advocate for members to obtain quality medical, vocational, educational and recreational services.
13. Help members develop skills that allow them to be functional in their home, work, family, and communities.
14. Ensures continuity of the individualized recovery plan by providing follow-up calls, communication with providers, and others involved in members' recovery.
15. Offer psychoeducation modules to help the member and family develop self-help skills for daily life activities.
16. Visit members at home as needed in order to support and follow up on the objectives of the individualized recovery plan and the integration of the family and other significant people.

How do I register the program?

FHC has multiple avenues for members to be considered for MCC services, including:

1. Referrals from your primary care physician
2. Referrals from high planners
3. Referral from the caregiver or self-referral
4. Referral from your mental health provider

To begin the referral process you must complete the referral form, as well as any other verbal or written communication to request an admission assessment to the Case Management Program. It is the responsibility of the case manager or supervisor to
evaluate the referral and determine whether the person meets the admission criteria. Referrals are accepted from the following sources:

1. Disease Management Program: Disease Management program staff are informed of the referral process through newsletters or by completing referral via the following link on the FHC website (Click Here).
2. Discharge Planners: Discharge planners can refer members to the Case Management Program through the following link on the FHC website (Presione aquí) or through the consultation process during frequent contacts with FHC clinical department staff.
3. Mental Health Professional: Mental health professionals are informed about their ability to refer through the following link on the FHC website (Presione aquí). Professionals are informed through the educational ones offered to providers by FHC. The mental health provider may also contact FHC by phone to make the referral.
   1. MCS Classicare: 1- 800-760-5691
   2. MCS Life: 1-866-627-4327
   3. Triple S Federal: 1-800-660-4896
   4. Guaynabo Township: 1-866-808-4614
4. Usage Review (UM): If at the time a request for authorization for a determination is reviewed, a member who could benefit from the Services of the Case Management program is identified, the reviewer makes a referral to the program through the different means of communication, including the FHC website (Presione aquí)
5. Member: Members are informed of their ability to self-refer to the Case Management Program through the following link on the FHC website (Presione aquí). The member can also contact FHC by phone to self-refer.
   1. MCS Classicare: 1-800-760-5691
   2. MCS Life: 1-866-627-4327
   3. Triple S Federal: 1-800-660-4896
   4. Guaynabo Township: 1-866-808-4614
6. Caregiver or Family Member: Caregivers may refer their family member to the Case Management Program through the following link on the FHC website (Presione aquí). The caregiver or family member may also contact FHC by phone to refer.
   1. MCS Classicare: 1- 800-760-5691
   2. MCS Life: 1-866-627-4327
   3. Triple S Federal: 1-800-660-4896
   4. Guaynabo Township: 1-866-808-4614
7. Primary Physician: Primary physicians are informed of their ability to refer via the following link on the FHC website (Presione aquí). Professionals are informed through the educational ones offered by FHC. The primary doctor may also contact FHC by phone to make the referral.
   1. MCS Classicare: 1-800-760-5691
   2. MCS Life: 1-866-627-4327
   3. Triple S Federal: 1-800-660-4896
   4. Guaynabo Township: 1-866-808-4614

What can I expect from the case handler?

The case handler offers the members:

• A professional service that guarantees confidentiality, in accordance with Law 408 and the Law on Accountability and Transferability of Medical Insurance (HIPAA).
• The handler will work with the member to achieve an optimal level of functioning in less restrictive treatment.
• The opportunity to contact public agencies that help the members work with their social stressors.
• Individual and personalized handling.
• Liaison between the member and their mental and physical health providers to ensure quality service.

Does this program replace the member's treatment?

No, the program is designed to support mental and physical health treatment services.

What is expected of the member and his/her family?

They are expected to make a commitment, not only to the program, but to their recovery and treatment, complying with the recommendations offered by both their health care providers and the case manager.