Monitoring and Follow-Up Activities. The claimable unit of TCM service is the provision of one of the four aforementioned case management service components in a face-to-face encounter with the client. m anagement provided by HCA’s TCM Program and by CalOptima. CalOptima’s case management primarily focuses on member medical needs in providing case management as the primary provider of client medical care. This may include case management of acute or chronic illness. I n contrast, HCA’s TCM Program focuses on the case management of individuals within specific target populations, including referring clients to providers to address medical issues, as appropriate.
Monitoring and Follow-Up Activities. The four component requirement applies to both TCM and MCP case management. TCM services do not include the direct delivery of underlying medical, social, educational, or other services to which an individual has been referred. The claimable unit of TCM service is the provision of one of these four service components in a face-to-face encounter with the client. MCPs will partner with LGAs to ensure that members receive the appropriate level of case management services. The collaborative process will ensure that there is no duplication of services. The MCP will oversee the delivery of primary health care and related care coordination. MCPs are responsible for providing all medically necessary health care identified in the care plan including medical education that the member may need as well as any necessary medical referral authorizations. Case management for member medical issues and linkages to MCP covered health services will be the responsibility of the MCP. MCPs will provide members with linkage and care coordination for any necessary social support need identified by the MCP that do not need medical case management.
Monitoring and Follow-Up Activities. Activities and contacts that are necessary to ensure the care plan is implemented and adequately addresses the eligible individual’s needs, and which may be with the individual, family members, service providers, or other entities or individuals and conducted as frequently as necessary, and including at least one annual monitoring, to determine whether the following conditions are met: Services are being furnished in accordance with the individual’s care plan; • Services in the care plan are adequate; and • Changes in the needs or status of the individual are reflected in the care plan. Monitoring and follow-up activities include making necessary adjustments in the care plan and service arrangements with providers. These activities may be conducted as specified in the care plan, or as frequently as necessary to ensure execution of the care plan. Monitoring does not include ongoing evaluation or check-in of an individual when all care plan goals have been met.
