Targeted Case Management Services. Contractor is responsible for determining whether a Member requires Targeted Case Management (TCM) services, and must refer Members who are eligible for TCM services to a Regional Center or local governmental health program as appropriate for the provision of TCM services. If a Member is receiving TCM services as specified in Title 22 CCR Section 51351, Contractor shall be responsible for coordinating the Member's health care with the TCM Provider and for determining the Medical Necessity of diagnostic and treatment services recommended by the TCM Provider that are Covered Services under the Contract. If Members under age 21 are not accepted for TCM services, Contractor shall ensure the Members’ access to services are comparable to EPSDT TCM services per Exhibit A, Attachment 10, Scope of Services, Provision 5. Services for Members under Twenty-One (21) Years of Age.
Targeted Case Management Services. In accordance with the Community Mental Health Rehabilitative Services manual and the policy manuals for the DD Waivers issued by the DMAS, the CSB shall be the only provider of rehabilitative mental health case management services and shall have sole responsibility for targeted DD case management services, whether the CSB provides them directly or subcontracts them from another provider. Individuals receiving case management services shall be offered a choice of case managers to the extent possible, and this shall be documented by a procedure to address requests for changing a case manager or for receiving case management services at another CSB or from a contracted case management services provider. The CSB shall provide a copy of this procedure to the Department upon request. During its inspections, the Department’s Licensing Office may verify this as it reviews services records and examines the procedure.
Targeted Case Management Services. If a Member is receiving targeted case management services as defined in Title 22, CCR, Section 51185 and Section 51351, Contractor shall be responsible to coordinate the Member’s health care with the targeted case management provider and to determine the medical necessity of diagnostic and treatment services recommended by the targeted case management provider that are Covered Services under the Contract.
Targeted Case Management Services. In accordance with the Community Mental Health Rehabilitative Services manual (page 15) and the MR/ID Community Services manual (page 6) issued by the DMAS, the CSB shall be the provider of rehabilitative mental health case management and targeted MR/ID case management services.
Targeted Case Management Services. Linkage services will be provided to assist children, TAY, and family members to receive appropriate services, arrange transportation to appointments and/or activities when needed, and help them perform activities of daily living. These services also include finding appropriate out-of-home placements, when necessary. Targeted case
Targeted Case Management Services. Targeted case management services are defined as services furnished to assist individuals, eligible under the State Plan, in gaining access to needed medical, social, educational and other services. Target groups defined by the State Plan Amendments include: 1) children under the age of 21; 2) medically fragile individuals; 3) individuals at risk of institutionalization; 4) individuals in jeopardy of negative health or psycho-social outcomes; and 5) individuals with a communicable disease. Targeted Case Management includes the following assistance:
Targeted Case Management Services. The Contractor shall be responsible for developing a system for coordinating health care for Medicaid MCO Members that require Targeted Case Management (TCM) services that avoids duplication and ensures that the Medicaid MCO Member’s needs are adequately met. TCM services are those services which will assist an individual eligible under the State Plan in gaining access to needed medical, social, educational and other services to include a systematic referral process to the service with documented follow-up. TCM services are available to alcohol and substance abuse individuals, children in xxxxxx care, chronically mentally ill adults, emotionally disturbed children, children in the juvenile justice system, sensory impaired individuals, individuals with mental retardation or a related disability, individuals with head or spinal cord injury or a related disability, children and adults with sickle cell disease and adults in need of protective services. Patients who are dually diagnosed with complex social and medical problems may require TCM services from more than one case management provider. A systematic referral process to Providers for medical education, legal and rehabilitation services with documented follow up to ensures that the necessary services are available and accessed for each eligible patient. TCM services available to members are outlined in MCO Policy and Procedure Guide. The Department has developed a Case Management Hierarchy to avoid duplication and to ensure the members’ needs are adequately met. TCM programs will remain fee-for-service as listed in MCO Policy and Procedure Guide. The Contractor and the Case Management Agency shall develop a system for exchanging information.
Targeted Case Management Services. In accordance with the Community Mental Health Rehabilitative Services manual and the policy manuals for the DD Waivers issued by the DMAS, the CSB shall be the only provider of rehabilitative mental health case management services and shall have sole responsibility for targeted DD case management services, whether the CSB provides them directly or subcontracts them from another provider. Choice of Case Managers Individuals receiving case management services shall be offered a choice of case managers to the extent possible, and this shall be documented by a procedure to address requests for changing a case manager or for receiving case management services at another CSB or from a contracted case management services provider. The CSB shall provide a copy of this procedure to the Department upon request. During its inspections, the Department’s Licensing Office may verify this as it reviews services records and examines the procedure. Access to Services The CSB shall not establish or implement policies that deny or limit access to services funded in part by state or local matching funds or federal block grant funds only because an individual: a.) is not able to pay for services, b.) is not enrolled in Medicaid, or c.) is involved in the criminal justice system. The CSB shall not require an individual to receive case management services in order to receive other services that it provides, directly or contractually, unless it is permitted to do so by applicable regulations or the person is an adult with a serious mental illness, a child with or at risk of serious emotional disturbance, or an individual with a developmental disability or a substance use disorder, the person is receiving more than one other service from the CSB, or a licensed clinician employed or contracted by the CSB determines that case management services are clinically necessary for that individual. Federal Medicaid targeted case management regulations forbid using case management to restrict access to other services by Medicaid recipients or compelling Medicaid recipients to receive case management if they are receiving another service. Virginia Psychiatric Bed Registry The CSB shall participate in and utilize the Virginia Psychiatric Bed Registry required by § 37.2- 308.1 of the Code to access local or state hospital psychiatric beds or residential crisis stabilization beds whenever necessary to comply with requirements in § 37.2-809 of the Code that govern the temporary detention pr...
