Targeted Case Management. If the LPHA, as a provider of Medicaid services, chooses to bill for Targeted Case Management-eligible services, the LPHA must comply with the Targeted Case Management billing policy and codes in OAR 410-138-0000 through 410- 138-0390.
Targeted Case Management. The IHH shall provide Targeted Case Management services as defined in Chapter 90 of the IAC to eligible members in an IHH.
Targeted Case Management. (1) The Health Plan shall provide behavioral case management services to Children/Adolescents in the care or custody of the State who need behavioral health targeted Case Management services, as defined in the Health Plan’s approved clinical protocols. These children shall not be transferred to the new Medicaid Child Welfare Targeted Case Management program. The Health Plan shall develop a cooperative agreement with DCF or their provider of community based services, to address how to minimize duplication of case management services and to promote the establishment of one case manager for the Child/Adolescent and family whenever possible.
Targeted Case Management. Children in the care or custody of the state who need mental health targeted case management services, as defined in the provider’s approved clinical protocols, shall receive mental health case management from the provider. These children will not be transferred to the new Medicaid Child Welfare Targeted Case Management program. The provider must develop a cooperative agreement with the Department of Children and Families or their provider of community based services, to address how to minimize duplication of case management services and to promote the establishment of one case manager for the child and family whenever possible.
Targeted Case Management. If the LPHA, as a provider of Medicaid services, chooses to bill for Targeted Case Management-eligible services, the LPHA shall comply with the Targeted Case Management billing policy and codes in OAR 410-138-0000 through 410-138-0390. NFP Services comply with the B1st! requirements and may be combined with Babies First! Targeted Case Management.
Targeted Case Management provided by Contractor will focus on client needs and strengths and that assist a client to access needed medical, educational, social, prevocational, and rehabilitative or other community services. Case Management services may include but are not limited to the following:
Targeted Case Management i. Case Management services are activities provided by the program staff to access needed medical, education, social, prevocational, vocational, rehabilitative, or other needed community services for eligible individuals. May include consultation, communication, coordination and referral; monitoring of service delivery to ensure an individual’s access to services; monitoring of the individual’s progress; and placement services.
Targeted Case Management. If the Grantee, as a provider of Medicaid services, chooses to bill for Targeted Case Management-eligible services, the Grantee must comply with the Targeted Case Management billing policy and codes in OAR 410-138-0000 through 410- 138-0390.
Targeted Case Management. The specific billing codes that represent this service area are listed on the Service Code Table. Additional policy information for this service area can be found in the ForwardHealth Online Handbook under the service area titled “Case Management, Targeted”.
Targeted Case Management. A module for documenting, reviewing and the download of a billing file of encounters for Targeted Case Management (TCM) is available and currently being utilized in Orange County by home visiting agencies. Users are identified as TCM billers through entry of their NPI numbers when their account is set up in the system and can be modified to turn them on or off as TCM billers during their time with the agency. The module and the TCM care plan currently in use was approved by the County of Orange LGA and each agency has a billing file customized with their billing identifiers. The module follows the workflow as prescribed by State regulations on setting up a new care plan, documenting encounters, providing periodic review, component code logic, and billing file layout. Each encounter follows four steps: entering visit information; assessing goals and needs; referral follow‐up/periodic review; and assignment of component codes. There is a confidential messaging component for supervisor‐staff communication regarding encounter review and ticklers built in to keep staff on track for referral status updates and periodic reviews. Clients eligible for TCM services are identified in the case record and information such as name, birthdate and Medi‐Cal numbers pull forward into the module. The TCM Encounter Log provides a list of encounters that have been entered into the system and can be sorted by those needing review, waiting for information, ready for billing, or plans needing follow up. This list can be filtered by date range, visit type and/or staff assigned. When using the encounter log the supervisor can message staff on issues that need to be resolved before an encounter can be deemed eligible for billing, see where there are issues by system flagging, and designate encounters as billable or not billable. Encounters to be billed can be done so as a group or can be hand selected by the supervisor. The system will provide a billing file which can then be downloaded and uploaded by staff into the State system. The NetChemistry system is designed to provide a solution to the case management, tracking and outcome needs required of multiple programs under CNSD. The current NetChemistry case management system features and functions would match the needs outlined in the current RFP. Table 2 compares the functional requirements of the NCMS against current NetChemistry features with notation where customizations are needed:
