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

2. 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?

3. 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

4. Process Researched model TCM documentation for Managed Care
Developed a modified Tennessee Format
Implemented Pilot October 2016
Required Format Effective February 2017

5. 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

6. 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.

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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.

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

14. Texana Center Contacts
Sheri Talbot, Director IDD Authority Services
Carin Shuford, Information Services Specialist