1. Presented by: Yasmin Hichborn, El Dorado County
TCM 101
Presented by:
Yasmin Hichborn, El Dorado County

2. Targeted Case Management (TCM)
What is It?
The TCM Program provides specialized case management services to Medi-Cal eligible individuals in a defined target population to gain access to needed medical, social, educational, and other services. The TCM Program is an optional Medi-Cal Program funded by federal and local funds.
Department of Health Care Services (DHCS) is the state agency with oversight of TCM

3. Who Participates in TCM?
Local Governmental Agency’s (LGA) Programs
Public Health
Public Guardian
Probation
Local Public Entities (LPE) such as Cities
Community Based Agencies (CBOs)

4. TCM (Budget) Unit & Funding
Determine the Program(s) for TCM participation
Review Fiscal Structure of Agency and Program(s)
Identify and Analyze Funding
Federal
County
Other Sources of Government Funding
Private Grants
Fundraising/Donations
Fees
Miscellaneous

5. CPE Requirement Certified Public Expenditures (CPE) are required
CPE may come from the Provider’s General Fund, or from any other funds allowed under federal law and regulation
Examples of CPE are:
County or LPE General Funds
Realignment
First 5
TCM Reimbursement

6. Targeted Populations for TCM
Children Under the Age of 21 (PPL )
Individuals who are Medically Fragile (PPL )
2 or more diagnosis
Individuals at Risk of Institutionalization (PPL )
Includes individuals transitioning to a community setting from a covered stay in a medical institution
Maximum of 180 consecutive days
Must actually transition to a community setting
Individuals in Jeopardy of Negative Health or Psycho-Social Outcomes (PPL )
Individuals with a Communicable Disease (PPL )

7. Possible TCM Staff Program Manager Program Supervisor Case Managers
Support Staff
Fiscal

8. Case Manager Requirements
Basic TCM Case Manager Requirements are:
Completion of at least a Bachelor of Arts degree for an accredited college or university who has completed an agency-approved case management training
----Or----
Completion of at least an Associate of Arts degree from an accredited college or university who has completed an agency-approved case management training and has two years of experience performing case management duties in a health or human services field
Completion of an agency-approved case management training course and has four years of experience performing case management duties in a health or human services field.

9. NPI Number
National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. It is a unique identification number for covered health care providers.
Required for all TCM Case Managers
Required for the TCM On-Line Invoicing System
Unique 10-digit number
Apply online at the CMS.gov website
Stays with Case Manager

10. Other Documents Required
Medi-Cal Targeted Case Management Provider Participation Agreement with Department of Health Care Services (DHCS)
Annual Participation Pre-Requisite (APP)
Performance Monitoring Plan (submitted annually)
Addresses Non-Duplication of Services
Case Management Service Coordination
MOU with Managed Care Entities
TCM Fee Schedule

11. Time Survey for TCM Staff
Who Time Surveys? TCM Managers/Supervisors TCM Case Managers TCM Support Staff Frequency: Perpetual (Less 100 participants) Quarterly: 20 Consecutive Work Days ( participants) 10 Consecutive Work Days ( participants) 5 Consecutive Work Days (400+ participants)

12. TCM Specific Time Survey Codes
Code 23 – Non-Targeted Case Management
Code 24 – Providing TCM Service Components
Code 25 – TCM Encounter Related Activities
Code 26 – Travel Related to Providing TCM
Code 27 – Supervision of Case Managers
Code 28 – Encounter Entry into TCM On-Line System
Code 29 – TCM Data Systems and Claiming Coordination
Code 30 – TCM Quality Assurance/Performance Monitoring
Code 31 – TCM Subcontract Administration
Code 32 – TCM Program Planning & Policy Development

13. Annual TCM Cost Report Due November 1st
Creates the Interim Encounter Rate
Three Main Components:
Financials for Program/Budget Unit
Time Surveys for Staff
Total TCM Encounters for Fiscal Year

14. Unit for Invoicing – The Encounter
Provided by a TCM Case Manager
An encounter is a defined as a face-to-face contact or a telephone contact in lieu of a face-to-face contact when environmental considerations preclude a face-to-face contact.
The purpose of the face-to-face visit is to provide one or more targeted case management service components.

15. TCM Encounter Locations
Home
Office
Other

16. Components of Encounters
Comprehensive Assessment and Periodic Reassessment
Development of a Specific Care Plan (Service Plan)
Referral and Related Activities
Monitoring and Follow-Up Activities

17. Creation of an Encounter Log
Created for a specific period of time
Contains Medi-Cal and Non-Medi-Cal Encounters
Used for invoicing TCM encounters
Contain the following information:
Case Manager # and/or Name
Social Security/Medi-Cal ID#
Date of Service
Date of Birth
Client Last Name
Client First Name
Middle Initial (optional)
TCM Encounter Location
TCM Encounter Component
TCM Target Population

18. Invoicing TCM Encounters
TCM On-Line Invoicing System
Encounters can be Uploaded in a Text Fixed File Format
Encounters can be Manually Entered
TCM On-Line System Identifies Uploaded Encounters as:
Claimable – Medi-Cal Eligible
Not-Eligible – Will provide reason
Pending
Duplicate

19. Invoices for Encounters
Created in the TCM On-Line System
Specific to Target Population
Created to Current Date or Specific Time Period
Print on LGA Letterhead, Sign, and Mail to DHCS
After Payment is Received for a Specific Invoice – Mark as Paid in the TCM On-Line System

20. Whichever is Later, per W&I Code 14170
Records Retention
All records in support of allowable TCM services must be maintained for the greater of:
A) Three fiscal years after the end of the quarter the LGA receives reimbursement from the DHCS for the expenditures incurred OR
B) Three fiscal years after the date of submission of the original or amended TCM Cost Report
Whichever is Later, per W&I Code 14170

21. Questions