Targeted Case Management (Tcm)

SOP 1.4.13

03/01/05

TARGETED CASE MANAGEMENT (TCM)

INTRODUCTION:

Targeted Case Management (TCM) services are provided to Medicaid eligible clients who are:

(a)  Children age zero (0) through twenty (20) who meet the conditions and circumstances to be defined as a child in the custody of or at risk of being in the custody of the state; or

(b)  Adults age twenty-one (21) or older who meet the conditions and circumstances to be defined as an adult in need of protective services.

TCM services are provided by qualified DCBS staff who appropriately document the delivery of a Medicaid covered TCM service.

See the Frequently Asked Questions (FAQ)

COA STANDARDS:

·  NA

LEGAL AUTHORITY:

·  907 KAR 3:020

·  Title V Services Provided by DSS (Medicaid Manual)

PROCESS OVERVIEW:

1.  Targeted Case Management services are those which will assist the targeted population in gaining needed medical, educational, social, and other support services. These services include:

(a)  A written comprehensive ongoing assessment (CQA), which has face-to-face contact with the child, adult, his family, or other collaterals needed to determine the individual’s needs;

(b)  Participation in the development of the individual’s Case Plan;

(c)  Coordination of, and arranging for, needed services as identified in the individual’s Case Plan;

(d) Assisting the individual and his family or person in custodial control in accessing needed services (both Medicaid or non-medical) as provided by a multiplicity of agencies and programs;

(e) Monitoring the individual’s progress through the full array of services by:

(1)  Making referrals;

(2)  Tracking the individual’s appointments;

(3)  Removing barriers which prohibit access to the recommended programs or services;

(4)  Performing follow-up on services rendered to assure the services are received and meet the individual’s needs;

(5)  Performing periodic re-assessments of the individuals changing needs; and/or

(6)  Educating the family or individual of the value of early intervention services and treatment programs.

(f)  Performing advocacy activities on behalf of the individual. The Case Manager may intercede to assure appropriate, timely, and productive treatment modalities;

(g) Establishing and maintaining current client records, documenting contacts, services needed, client’s progress, and any other information as may be required;

(h) Providing case consultation as required (i.e., consulting with a service provider to assist in determining the individual’s progress, etc.); and

(i)  Providing crisis assistance (i.e., intervention on behalf of the individual, making arrangements for emergency referrals and treatment, and coordinating any other needed emergency services).

2.  A eligible qualified Case Manager meets the following minimum qualifications:

(a)  A Bachelor of Arts or Bachelor of Science degree in any of the social/behavioral sciences or related fields from an accredited institution; and

(b)  One (1) year of post bachelor experience working directly with the targeted population or performing case management services;

Note: A Master’s degree in a human service field can substitute for the one (1) year experience.

(c)  Only the qualified Case Manager of record may enter documentation for TCM services.

3.  Case Management Services do not include: Agency Services not coded to TCM include:

(a)  Investigations, FINSAs;

(b)  Domestic Violence Cases;

(c)  The actual provision of treatment;

(d)  Outreach activities to potential clients;

(e)  Administrative activities associated with Medicaid eligibility determinations, application processing, etc.;

(f)  Institution discharge planning, such as hospital or nursing facilities, as these facilities are required to provide this service as condition of payment. The Case Manager may bill, however, for services performed either in the month prior to or month of discharge from the facility to prepare the individual’s return to the community;

(g)  Transportation services solely for the purpose of transporting the individual regardless of the reason for the transport; and

(h) Duplication of payments to public agencies or private entities under other program authorities for the same purpose.

PROCEDURES:

1.  The eligible qualified Case Manager enters TCM contacts only for those cases where the Case Manager:

(a) Meets Medicaid eligibility requirements; and

(b) Provided valid TCM services.

2.  TWIST documentation requires that the individual client:

(a) Has a valid Social Security Number (SSN), which is matched in KAMES (the matching is done automatically by TWIST);

(b) Has a correct Date of Birth (DOB);

(c) Has an address entered in “Present Location;” and

(d) Is listed in the “On Behalf Of” box in TWIST.

3.  The eligible qualified Case Manager enters the following in TWIST:

(a) The eligible Individual(s);

(b) The exact Contact Date;

(c) The Contact Location;

(d) The Contact Type;

(e) The Purpose of Contact; and

(f)  One of the following Service Activities:

(1) TCM Advocacy;

(2) TCM Arranging Delivery of Services;

(3) TCM Assessing Needs;

(4) TCM Assist Access of Needed Services;

(5) TCM Case Consultation;

(6) TCM Crisis Assistance; or

(7) TCM Tracking Referral, Follow-up…

4.  The eligible qualified Case Manager ensures that the Contact Comments are concise, professional, and pertain to the goals established for the child/family and document the delivery of a covered TCM services as referenced in Procedure #3(f).

5.  Contacts that are unsuccessfully completed are not documented as a completed TCM. In instances where a face-to-face or telephone contact was initiated and no one was home or answered the telephone, the eligible qualified Case Manager selects “Face to Face Worker Initiated Negative” or “Telephone Initiated by Worker Negative.”

(Tip Sheet regarding TCM)