Targeted Case Management Monthly Documentation Update Texana Center Sheri Talbot, Authority Services Carin Shuford, Information Services

Objectives Goal: Why did we do this? Process: What did we do? Challenges: How did we meet the state requirement in a format intended for monthly billable case rate? Recommendations: What is our message to the state to support a monthly summary note?

Goal Expectations of state for progress/lack of progress/satisfaction/lack of satisfaction every 90 days Documentation burden to TCMs (turnover) Compliance challenge – missing outcome/missing service in 90 day reviews Expectations for transition to managed care: Maximize the use of data to drive decision making Desired Outcomes of the Monthly Documentation Summary Improved time management Improved compliance Improved quality of Service Coordination

Process Researched model TCM documentation for Managed Care Developed a modified Tennessee Format http://www.tn.gov/assets/entities/didd/attachments/80.3.4_-_ISC_CM_Monthly_Doc_Form.pdf Implemented Pilot October 2016 Required Format Effective February 2017

Challenges Challenge with Tennessee Model: Tennessee Single Monthly F/F = Billing Requirement; Texas 1 F/F and 2 Collaterals = Billing Requirement Matching billing strips with Monthly Summary elements (F/F, Collateral, Provider Review, and Outcome/Service Review) Populating outcomes: Developed outcomes for life domains rather than services Service Coordinators omitting elements (Outcome/Service Review) vs. Requiring all elements monthly Final approval and billing at the end of the month

Texana Center Monthly Progress Note Components of the Monthly Summary: Billable Face to Face Services (Narrative) Billable Collateral Services (Narrative) Provider Summary, a billable collateral review of services with a provider representative. Structured data fields which provide reporting options. Outcome/Service Review with Outcomes populating from the PDP. Structured data fields which provide reporting options. Flexibility to add other elements based on client’s needs, required reporting for ECC as an example.

Recommendations: Message to the State Need to prepare for Managed Care environment Simplify billing processes MCOs do not have A/B processes Advocate for Monthly Case Rate Implement Service Component Codes to capture measurable data elements (Similar to PASRR Service Coordination activity codes, but not linked to billing) Add reporting options to define purpose of contacts Retain ability to demonstrate the value of IDD Targeted Case Management Frequency of f/f with clients Frequency of contacts with family and providers

Recommendations: Message to the State Need to prepare for Managed Care environment Prepare for reimbursement based on performance outcomes Performance Outcomes to Capture in TCM Note Assessments Health and Safety Risks Participation in Planning PDP Meeting Needs and Preferences PDP Implemented within Timelines Protection of Participant in an Emergency Participant Choice Participant Satisfaction Participant Needs are Met Participant is Safe

Recommendations: Message to the State Need to lessen the documentation workload for TCM Narrative documentation requirements combined with the quantity of TCM notes for a caseload of 42 is unmanageable for the skill level of a majority of Service Coordinators. Leads to Burnout Noncompliance with CAO expectations Fraudulent documentation Termination: Voluntary and involuntary Turnover impacts quality and effectiveness of TCM for individuals Turnover is costly to LIDDAs: Recruiting, Hiring and Training

Recommendations: Message to the State Suggestions for Revisions to State Billing Guidelines Service coordination funded by Medicaid as TCM is reimbursed at Monthly Case Rate with the completion of a Monthly Summary Note that Documents and bills the provision of TCM: F/F with Individual for the purpose of: Assessment Service Planning/Coordination Structured Data fields to capture timeliness Monitoring Structured Data fields to capture required 90 day review of Outcomes, Services and Satisfaction Crisis Prevention/Management

Recommendations: Message to the State Suggestions for Revisions to State Billing Guidelines Summarizes, with structured data fields, other activities (collaterals) completed by the Service Coordinator to support the individual: Gathering information to assess the status of the individual Monitoring the status of the individual Assisting with linking, referrals or benefits eligibility Service Planning, Coordinating and following up to issues Protecting the individual in an emergency

Recommendations: Message to the State Suggestions for Revisions to State Billing Guidelines For the month, summarizes, with structured data fields, the following: The individual’s receipt of meaningful supports that are consistent with what is important to and important for the individual. Access to the PDP by the individual and Service Planning Team. Provision of services in the amount/frequency authorized by the PDP/IPC. Overall satisfaction of the individual and family with the provision of services. Any identified health and safety risks, or changes in condition Next steps to be taken by the Service Coordinator in the following month.

Moving Forward Demonstration: What could a monthly summary TCM note look like if the state implemented these revisions to the state billing guidelines?

Texana Center Contacts Sheri Talbot, Director IDD Authority Services Sheri.talbot@texanacenter.com 281-239-1386 Carin Shuford, Information Services Specialist Carin.shuford@texanacenter.com 281-239-1447