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Case Management


Case ManagementWhether it’s coping with a mental health or substance use issue or living with an intellectual disability, behavioral health issues can affect your daily life in many profound ways. It can also make independence a challenge. Horizon’s case managers ensure that clients get the treatment they need. Our professionals meet with clients to make sure they are satisfied with the services they are receiving and to assess the need for additional services at Horizon and in the community.

When someone is diagnosed with an intellectual disability, they need an advocate in order to receive proper care and to live their lives in the most independent and fulfilling way possible. Horizon case managers navigate the state process to obtain and manage a state waiver. These waivers provide a combination of standard medical and non-medical services.

Criteria for Admission: Proof of documentation that a psychological evaluation has been done to diagnose an individual’s intellectual disability prior to age 18. A child under 6 years old will require developmental testing.
Waivers are administered by the state to deliver and pay for health care services by Medicaid and the Children’s Health Insurance Program (CHIP). Often times, because of the complexity of the state funding, a professional will be required to manage it.

There are four primary types of waivers:

  • Section 1115 Research & Demonstration Projects

  • Section 1915(b) Managed Care Waivers

  • Section 1915(c) Home and Community-Based Services Waivers

  • Concurrent Section 1915(b) and 1915 (c) Waivers

For more information regarding these waivers go to Medicaid.gov.

Criteria for Admission: Proof of documentation that a psychological evaluation was done to diagnose an individual’s intellectual disability prior to age 18. A child under 6 years old will require developmental testing. There must also be deficits related to level of functioning.
Studies show that people with a substance use disorder have better treatment outcomes if their other mental health issues are addressed at the same time. But finding and managing treatment can be overwhelming. Horizon’s Case Managers act as a single point of contact to help manage and advocate for clients.

Criteria for Admission: There must be documentation of the presence of a substance related disorder which meets Diagnostic and Statistical Manual of Mental Disorders -5 criteria.
The severity of a mental health disorder can dictate how much care is needed for an individual. Mental health case management can become extremely important when adults or children need multiple services as a part of their behavioral health treatment. A Horizon case manager can act as a single point of contact with health and social services, mobilizing needed resources and finding the best and most appropriate care for the client.

Criteria for Admission: For adults, there must be documentation of the presence of serious mental illness. For children or adolescents there must be documentation of a serious emotional disturbance or a risk of serious emotional disturbance.
This is a service provided to children and their families when the child is at risk of needing residential placement or is in a residential placement due to emotional or behavioral issues. The goal is to maintain the child in his home and transition him back to the community with the natural and professional supports in place to meet the child’s needs. Adult and child mental health case management can continue when the family has completed this program.

Criteria for Admission: Children are referred to this service through the Comprehensive Services Act (CSA).
In some cases, our clients need more intensive adult or child behavioral health treatment due to their vulnerability. If they meet the criteria set forth by the U.S. Department of Justice then they can qualify for enhanced case management.

Criteria for Admission: Per the U.S. Department of Justice Settlement Agreement with the Commonwealth of Virginia, a monthly face to face meeting is required with clients that: a) receive services from a provider with a Conditional or Provisional License, b) have more intensive behavioral or medical needs as defined by the Supports Intensity Scale (SIS), c) have an interruption of service greater than thirty days, d) encounter the crisis system for a serious crisis or, for multiple less serious crises, within a three month period, e) have transitioned from a Training Center within the previous twelve months, f) resides in a congregate setting licensed for five or more individuals, or g) lives in a congregate setting of five or more individuals.