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Targeted Case Management (TCM) Reimbursement for the Alameda County TB Program Jennifer Howser, MSN, PHN, RN Alameda County Health Department TB Control Program
Learning Objectives: • By the end of this presentation you will be able to: • Define Targeted Case Management • Describe Targeted Case Management services and components • Differentiate between billable and non- billable Targeted Case Management services • Give examples of how Alameda County provides Targeted Case Management services
What is Targeted Case Management (TCM)? • A federal reimbursement program administered by the state for case management services • Specific services provided by skilled public health professionals who meet federal case managers qualifications (e.g. PHNS)
Why do TCM??? • Reimbursement for services • Quality care for TB clients and their families
What are TCM Services? • Services which assist Medi-Cal eligible individuals to gain access to needed medical, social, educational and other services • Medi-Cal individuals must be in one of the target groups specified under the federal program
TCM Services • TCM services must be offered to all clients • In Alameda County, case managers document the service activity regardless of Medi-Cal eligibility • Services provided to Medi-Cal eligible clients are reimbursable through TCM
TCM Service Components • 1. Comprehensive documented assessment • 2. Written, comprehensive individual service plan • 3. Linkage and consultation • 4. Assistance accessing services • 5. Crisis assistance planning • 6. Periodic evaluation of services
Requirements for Public Health TCM Program • Services are face to face • Client must verify that he is not receiving duplicated case management services • Each encounter must identify case manager and date of service • Documentation of at least one of the six service components for each encounter
Billable TCM Encounter Examples • A case manager visits a TB client face to faceand performs a comprehensive assessment of the needs of the client and their family members • A case manager assists the TB client in accessing needs identified in the assessment such as food vouchers, housing or transportation to a medical appointment
TCM Does NOT Pay for: • Direct patient care such as TB skin testing, physical assessments, injections, etc. • DOT • Education • Epidemiological Investigation
Non-Billable Activity Examples • A case manager talks with a TB client on the phone and refers him/her to a medical provider • During a face to face visit, the case manager only does DOT • During a face to face visit, a PHN case manager ONLY conducts contact investigation activities
Establishing Rate of Reimbursement • A yearly rate is established via a time study of one month • Establishing a rate includes everything it takes to do the job such as: Travel time Consultation with providers Translation Clerical support services which provide support to TCM
Alameda County’s TB Program • PHNs qualify to perform TCM • The PHN case manager: • performs comprehensive case management • Arranges housing, food, transportation for TB clients • Links clients to needed service providers
About Alameda County…. • Over 700 square miles; urban, rural, suburban • No County Clinics -All Private Providers • 152 cases reported in 2005 • Designated TB Unit of 9 PHNS, 7 Outreach workers • Comprehensive case management and medical monitoring
Example of TCM Component:Assistance with Accessing Services • A Case Manager helps a TB client to access services identified in service plan • Arranging appointments or transportation • Arranging translation services • Arranging child or respite care NOT PROVIDING SERVICES– Direct Service Providers are not eligible to bill TCM
Example of TCM Component:Linkage and Consultation • Referring clients to needed services • Linking clients to service providers NOTE: Referrals must be followed up within 30 days to see if the needs were met
County TCM Support Structure • The local government authority (LGA) coordinator who assures compliance with federal, state, county program requirements • Current TCM provider agreement with the California Dept. of Health Services To start a TCM program, go to your county’s MAA/TCM LGA Coordinator
IN CONCLUSION……. • The California Department of Health Services website is the primary resource for TCM program requirements. These are in the TCM Provider manual, and there’s a link from the TCM home page: www.dhs.ca.gov/tcm • For a list of LGA MAA/TCM coordinators by jurisdiction (it’s the same person in every jurisdiction) go to: www.maa-tcm.net. The list is under the “Contacts” link.