Presentation on theme: "Targeted Case Management"— Presentation transcript:
1 Targeted Case Management GUIDELINES, DOCUMENTATION,AND BILLINGPRESENTED BY:THE DEPARTMENT OF HEALTH CAREPOLICY AND FINANCINGANDTHE DIVISION FOR DEVELOPMENTAL DISABILITIES
2 Background Designated by Waiver Case Management in Colorado Administrative Case ManagementCase Management as a Waiver ServiceTargeted Case ManagementDesignated by Waiver
3 Overview State Plan Benefit Targeted Population Entitlement Benefit Persons with Developmental Disabilities; andEnrolled HCBS-DD, SLS, or CES; orEnrolled in Early Intervention Services; andMedicaid Eligible
4 CMS Assurances The State Assures that: Clients will have free choice of providersCase management services will be provided in a manner consistent with the client’s best interestCase management services will not be used to restrict a client’s access to other servicesClients will not be compelled to receive case management servicesCase managers cannot authorize or deny other State Plan services
5 Qualified Providers Community Centered Boards Case Managers Only legally authorized agencies to provide TCM to individuals with DD in community settingsCase ManagersAppropriate qualifications to provide TCMBachelor’s Degree,Five years experience in the field of developmental disabilities, ORSome combination of education and experience
6 Purpose Facilitate Enrollment Service Plan Development Service MonitoringEffectiveEfficientCoordination of Services/BenefitsEducationalMental HealthEmotionalSocialMedicalEnsure Non Duplication of Services
8 Reimbursement Specifically Defined Activity and Purposeful Outcome Example: Telephone contact toschedule IDT MeetingBill in 15 minute increments1-15 minutes = 15 minutesContinuous Activity with SeparatetasksExample: Record Review, TelephoneContact, Service Plan RevisionBill Total Time SpentState of Colorado
9 Reimbursement Multiple Client Contact Multiple Contacts – One Day Example: Monitoring Visit with4 Clients at the same Group HomeEstimate time/unit per individualMultiple Contacts – One DayExample: Client calls 10 times inone dayProfessional JudgmentNumber of units billed should not exceed total amount of time worked.State of Colorado
10 General Contacts Direct Contacts Indirect Contacts Face-to-Face Email CorrespondenceIndirect ContactsConsultation with supervisor for the purpose to plan or coordinate need servicesDocumentation of TCM ActivitiesDocumentation and Review of Documentation for the purpose of the individual recordReview and distribution of records for planning, coordinating, assessing, and referral to services.
11 Billable Activities Comprehensive Assessment and Periodic Reassessment Determine need for:Medical, Educational, Social, Other ServicesExamples:Client HistoryAssist in accessing benefits e.g., Social Security and/or Medicaid re-determinationObtain and review any relevant and/or required assessments needed for service planning
12 Billable Activities Service Plan Development Based on information collected through assessmentSpecifies goals for meeting all service needsMedicalSocialEducationalOther ServicesActivities to ensure client participationWork with individual and others to develop goalsIdentifies course of action
13 Billable Activities Service and Support Coordination Coordination of the services being provided in the Service Plan to ensure continuity of service provisionReferral and Related ActivitiesHelp individual obtain needed services and activities and link them to the appropriate provider:MedicalSocialEducationalOther Programs
14 Billable Activities Monitoring and Follow Up Activities Services are: Implemented and delivered according to Service PlanAdequately meeting the individual’s needMonitor changes in needMake necessary changes/revisionsProvide Notification
15 Billable Activities Monitoring and Follow Up Activities cont. Health & safety needs are metRights are respectedClient Satisfaction
16 Administrative Activities Intake and Eligibility DeterminationReporting and Aggregating DataCritical IncidentsComplaintsAgency MeetingsCase Management/StaffTrainingProfessional DevelopmentalUtilization ReviewULTC 100.2SIS
17 Benefits Utilization System DocumentationBenefits Utilization SystemIf it didn’t happen on the BUS, it didn’t happen . . .
18 Benefits Utilization System DocumentationReimbursement based on BUS DocumentationLog notes document unitsReports generated by the BUSSupport claims paidBenefits Utilization SystemIf it didn’t happen on the BUS, it didn’t happen . . .
19 Documentation Date Time Units Drop Down Menu 15 Minute Increments The BUS will generate a date and time of entryCM should reflect within the log note the date/time of the activity notedTimeRecord when appropriatePertinent to the activityUnitsDrop Down Menu15 Minute IncrementsRecord Units up to 32 Units (8 Hours)
20 Activity Documentation TCM activity that is being performed Multiple related activities or activities performed within a single day may be entered into a single log noteMust be a billable activityType of contactDirectIndirect
21 Documentation Finding Follow Up Action The observations, assessments, or outcomes of the activity.Follow Up ActionThe actions to be taken with the information obtained from the activityWhen appropriate
22 Appropriation Ethical and Professional Reporting Considerations Budget Neutrality