APPENDIX H CASE MANAGER CERTIFICATION ADULT …
Mental Health Targeted Case Management Coverage and Limitations Handbook
APPENDIX H CASE MANAGER CERTIFICATION ADULT MENTAL HEALTH TARGETED CASE MANAGEMENT
Agency Name Agency Address
Phone Number ( )
Medicaid Provider # ___________________________________
Is hereby certified as having met the requirements for provision of adult mental health targeted case management. This individual is employed by an agency certified to provide adult mental health targeted case management services and meets the following criteria:
1. Has a bachelor's degree from an accredited university or college with a major in counseling, social work, psychology, criminal justice, nursing, rehabilitation, special education, health education, or a related human services field (a related human services field is one in which major course work includes the study of human behavior and development) and has a minimum of one year of full time or equivalent experience working with adults experiencing serious mental illness; or
Has a bachelor's degree from an accredited university or college and three years full time or equivalent experience working with adults experiencing serious mental illness.
2. Has completed AHCA-approved case management training or will complete AHCA-approved case management training within three months.
3. Has knowledge of available resources in the service area for adults with serious mental illnesses.
4. Is knowledgeable of and will comply with state and federal statutes, rules and policies that effect the target population.
______________________________________________ Case Manager
______________________________________________ Case Manager's Supervisor
________________________ Date
________________________ Date
Provider Administrator
_______________________ Date
AHCA-Med Serv Form 028, July 2006 (incorporated by reference in 59G-4.199, F.A.C.)
July 2006
H-1
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