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Adult Services

TARGETED CASE MANAGEMENTTARGETED CASE MANAGEMENT

Introducti

on to TCM

• The South Carolina Department of Health and Human Services is the single state agency in SC responsible for administration of medical assistance under Title XIX of the Social Security Act.

• Medicaid is the largest insurer of healthcare in the state.

• Some services are optional while others are mandatory and must be made available to all Medicaid beneficiaries.

• Optional services allow for the funding of community services normally not covered by Medicaid.

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Targeted Case

Management

• A TCM program is one of the optional services under Medicaid.

• Allows States flexibility to target case management services to specific classes of individuals.

• Must be medically necessary.

• Our SC State Medicaid Plan was amended to incorporate the provision of Case Management for Adults who meet certain criteria.

• Improve client access to community based services.

• Reduce the need for costly institutionalization.

• Make it possible for more adults to reside in local community settings.

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Introduction to TCM (continued)

DSS/APS and TCM

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• December 2007, The Centers for Medicare and Medicaid Services (CMS) proposed changes to Case Management Regulations.

• Proposed rule was later rescinded .

• In accordance with Medicaid third party liability, Medicaid would only be liable for the cost of case management services if there are no other third parties liable to pay.

• Activities performed and completed as a function of adult protective services (such as investigations) are not billable to Medicaid. Those are seen as state expenses that should not be cost shifted to Medicaid.

TCM Philosophy

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• TCM is a partnership between the Targeted Case Manager and the adult client and his/her family.

• Eligible adults and family (as appropriate) should be active participants in service planning .

• The Adult’s needs/preference should be considered and addressed holistically

• Organized strategies should empower the adult/family to carry out their responsibilities.

• TCM is positively impacted by a demonstrated respect for cultural variations among families.

TCM Philosophy (cont.)• Crucial that the Targeted Case

Manger identify and understand cultural beliefs, values, attitudes and mores by which individuals and families operate.

• TCM effectiveness is enhanced when integrated with other services and resources identified through a system’s perspective.

• Interagency collaboration is crucial to ensuring the client’s needs are adequately met without duplication of services.

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What is TCM?

• TCM refers to services which will assist the eligible adult in gaining access to needed medical, social, educational, and other services.

• Provides for the delivery of those services in an organized and coordinated way to meet the goals and objectives of an individualized service plan.

• Periodically monitors and re-evaluates progress in the attainment of these goals

• Allows for the provision of ongoing support and assistance to the adult/family in coping with change and making decisions that will enhance their independent functioning.

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Who Is Eligible for Adult TCM Service?

• Functionally Impaired Adults (FIA)• Must be Medicaid eligible; and• Individuals must be eighteen years of age or older; and• Individuals who lack formal and/or informal resources to

address their mental and physical needs; and• Individuals who are unable to perform at least one Activity

of Daily Living (ADL) as defined in the State NF LOC Criteria; and

• Be in need of Targeted Case Management Services

NOTE: This does not include individuals who are placed in institutions for mental disease or individuals who are inmates of public institutions.

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Eligibility

Criteria for TCM

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• Must lack formal or informal resources:

An individual who lacks formal and/or informal resources to address their emotional, psychological, and physical needs.

• Has a physical and/or mental impairment

a. An individual who is impaired in the ability to adequately provide for their own care or where no one else (family or other individual) is available to help in the client’s care; or

b. An individual who requires supervision in a structured environment due to at-risk factors to include cognitive and/or physical impairment.

Be unable to perform at least one Activity of Daily Living

The Activity of Daily Living (ADL) deficits are:

1. Locomotion - How the client moves between locations in his/her room and living area.

2. Transfer - How the client moves between surfaces (to/from: bed, chair, wheelchair, standing position).

3. Dressing - How the client puts on, fastens, and takes off all items of clothing, including donning/removing prosthesis.

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Has at least one activity of daily living deficit (cont.)

4. Eating - How client eats and drinks, including meal preparation.

5. Toilet use - How the client uses the toilet (or commode, bedpan, urinal): transfer on/off toilet , cleanses, changes pad, manages ostomy or catheter, adjusts clothes.

6. Bathing - How client takes full-body bath/shower, sponge bath, and transfers in/out of tub/shower (exclude washing of back and hair)

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Has at least one activity of daily living deficit (cont.)

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7. Continence Self-control - How client controls bowel movement and urinary bladder function.

8. Communication - Does client have a hearing problem, how well they make self understood, ability to understand others, speech clarity, modes of expression and ability to see in adequate light and with glasses if used.

Eligibility

Criteria (Continued)

Be in need of Targeted Case Be in need of Targeted Case Management Services. Management Services.

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CHANGES IN TCM

• Start and End times must be documented.

• Billable activities do not include the investigation of abuse or neglect for APS.

• Required Intake functions are NOT billable.

• Staff qualifications and required training .

• TCM records shall be retained for a period of five (5) years

• TCM Freedom Of Choice Form.

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Staff Qualificatio

ns

• Master’s degree in Social Work, Psychology, Counseling, Special Education, or related field; or

• Baccalaureate degree in Social Work, Psychology, Counseling, Special Education, or related field and one (1) year of experience working with the target population; or

• Baccalaureate degree in an unrelated field and three (3) years of experience working with the target population.

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Staff Qualifications (Cont.)

• All case managers who do not have professional licenses must have a minimum of ten (10) hours relevant in-service training per calendar year (the annual ten-hour requirement will be on a pro-rated basis during the first year of employment). The training must be relevant to the target population.

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Staff Qualifications (Cont.)

• Training documentation shall include topic, name and title of trainer, training objectives, outline of content, length of training, location, and outcome of training. Topics for specific in-service training must be relevant to the target population.

• Passing of State approved certification training course.

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Staff Qualifications (Cont.)

• Case managers must have a current valid driver’s license.

• Background checks are required and must not have any felony convictions of any kind in past 10 years.

• Documentation of all staff qualification requirements must be maintained in the TCM CM’s personnel folder for each case manager.

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Core Components

of TCM

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• Assessment (Process)• Care Planning / Service Plan• Referral and Linkage• Monitoring and Follow-Up

Requirements That Have

Not Changed

• The Targeted Case Manager must develop a Plan of Care called a Case Management Plan (CMP) (The Service Plan)

• Comprehensive plan based on an assessment

• All activities of the CMP must relate to objectives and clearly identify who will do what and when

• Case Managers are responsible for assuring access to care and monitoring the quality and appropriateness of services

• All TCM activities must be documented in an Activity Note (AN) (Service Notes)

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Assessment

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Assessment• Assessment is the first billable activity.

• Assessment is the process of gathering individual history, identifying the needs of the individual, and gathering information from other sources such as family members, medical providers, social workers, and other knowledgeable individuals to form a complete assessment of the eligible individual.

• The Assessment supports the selection of activities necessary to meet the assessed needs.

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Assessment (Cont.)

• The assessment of the adult client is the basis for the development and re-assessment of the Case Management Plan (Service Plan).

• Examples: gathering information from a Psychologist (psych. evaluation), Social Worker, information from service providers, family members, medical providers, etc.

• Preparing written report that details the mental/emotional health, environmental factors, history, treatment or progress for physicians, other service providers and agencies.

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Assessment (Cont.)• You can not bill Medicaid until an

Assessment has been done and documented in an Activity Note.

• Prior to the completion of the Case Management Plan, an Assessment should be completed to identify strengths, weaknesses, resources, problems, and service or medical needs.

• Staffing with supervisor to assist with identifying services and needs to facilitate targeted case management and assist with forming a complete assessment of the Adult.

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Documenting Assessments

• You must use the word “Assessed”• You must document what you assessed:

– Medical information– Psychological Evaluation– Information from service providers– Personal History– Caregivers or others knowledgeable in

community• You must detail the outcome of your

assessment• For Adult Services, you must complete the

Adult Services Risk Assessment form in CAPSS

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AssessmentExample Notes

a. Contacted adult’s daughter, Mrs. J Smart, to gather information about the adult’s ability to care for himself in his home and what family members are in the community to help in his care. Mrs. Smart stated caregiver lives alone and she is the only relative in the community. She works and has young children at home to care for. The client will need help to stay at home in the future due to his dementia.

b. Contacted adult’s day care program at Memphis Council on aging to gather information about how adult is currently functioning in the day program and assure that services will continue.

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AssessmentExample Notes

c. Contacted adult’s therapist at Columbia LRADAC to inquire about the number of sessions that adult has attended. Gathered information from therapist, Jane King, about her recommendation of the need for further treatment and estimation of number of additional appointments to help client deal with drug issues.

d. Contact client’s physician John Doe to gather information to identify medical needs.

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Case Manageme

nt Plan

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Developing The Case

Management Plan

(CMP)

• The CMP is the client Service Plan for Adult Services and must be completed in CAPSS.

• Individualized and based upon the mutual identification of problems and determination of goals (client should be involved as appropriate).

• A copy of the CMP printed and given to the adult and/or family/guardian and documented in an Activity Note.

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Client’s name. Medicaid #, DOB,

Doris Harley, Human Services Specialist I

Service Plan

Example

CMP (Cont.)

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The CMP must document the following:• Identification of the adult’s needs• Address the needs of the adult and/or

family• Actions required to meet the

identified service needs • Strengths and weakness of

adult/family• Frequency of services should be

addressed if applicable

Identify the Problem(s) / Need(s)

Examples:• Activity of daily living (ADL) deficit• Level of Functioning• Medical Status • Emotional Status• Family Dynamics • Individual/Family Support System• Current Living Environment• Financial Status• Community Involvement • Educational and Vocational Placement, if

applicable• Socialization and Relationships with Others• Services Received or Needed from Others

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Examples of Needs/Problems

• Mike just recently lost his grandfather. He needs to address his grief.

• John needs to address anger management due to his violent outbursts.

• Robert needs better social skills based on his inability to work well with others.

• Mary needs assistance bathing due to physical issues.

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Developing Activities to Meet the Need, Responsible Authority, and

Frequency • State what must be done to meet the

established need/problem • Individualized to the adult • Measurable • Realistic • Understandable • Adequate • Consistent • Specific rather than broad• Time/frequency

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(Continued)• Activities are identified to specifically

detail how to assist the adult/family in meeting their need.

• Contact providers and other agency members (as applicable) to participate in the care planning process.

• Responsible Authority indicates other potential service providers if they have the ability to meet a particular adult/family need (APS can not be listed as the responsible authority).

• Frequency of activities should be addressed, if applicable.

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Examples of Activities/Responsible Authority/Frequency

• Mike will be referred to grief counseling provided by Westview Mental Health Center.

• John will be referred for anger management counseling at Charleston County Mental Health to occur weekly.

• Robert will be referred for socialization to the Aiken Council on Aging day program 2 times per week.

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Completion Dates

• Projected Completion Dates – The date that you project that the activity will

be completed– Must be written with month and year– Should be individualized and realistic

• Actual Completion Dates– The date the activity was completed or closed– Must be written with month, day, and year

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Signatures, Title, and Dates

• The Targeted Case Manager ‘s signature, title, and date activates the CMP.

• The TCM staff’s title must be listed as Case Manager (CM or AS/CM).

• The TCM Case Manager must sign every page of the CMP if it is printed and not done in CAPSS.

• SCDHHS will accept the electronic signature, title and date generated by CAPSS.

• The adult and/or family/guardian must sign the CMP and receive a copy. If the adult and/or family/guardian is not available, the Activity Note (AN)/Service Note must document why the signature could not be obtained.

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Medicaid Requirement

s

• CMP must be completed thoroughly, signed, titled, and dated by a credentialed TCM Case Manager (if done in CAPSS, SCDHHS will accept the electronic identifier for signature.

• The CMP activity must be documented in a corresponding Activity (Service) Note.

• CMP must be reviewed at least every six months per Adult Service.

• A new CMP must be completed, at a minimum, every 365 days and documented in an Activity Note (note this is days and not months).

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Documenting CMP Development

• You must document that the CMP was developed in consultation with the adult/family or a detailed explanation as why not in case notes.

• You must document that the CMP was signed by the adult/family, and if not signed provide a detailed explanation as why not.

• You must provide a signed copy of the CMP to the adult/family and document that a copy was given (Print Service Plan out of CAPSS-do not modify outside of CAPSS-sign, title and date).

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Care Plan Example Notes

a. Documented adult’s history and current medical status to forward to new physician Joan Doe.

b. Contact Lexington DMH counselor Jean Doe to notify of care plan meeting so that she may participate in the client’s care planning process.

c. Contacted adult’s daughter, Mrs. Smart to give information to and asked her to participate in the formulation of the Care Plan/Care plan meeting.

d. Convened a meeting to develop or complete a period revision of the CMP.

e. Contacted the client and/or family to discuss changes in the CMP.

f. CM coordinated needed medical transportation for client’s appointment with psychiatrist, Dr. John Doe.

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Referral and Linkage

An adult may need multiple services from multiple providers.

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Referral and Linkage

• This component includes activities that help link adult with providers, programs, and services that are capable of providing the assessed needed services

• Activities that help link the adult with providers or programs

• Examples: making referrals to providers for services needed that are identified on the CMP, scheduling appointments, calls to potential providers, preparing written documentation to providers, etc.

• Arranging for transportation to a service. (Transporting a client to a service is not billable)

• Calls to potential providers to access the availability of the service

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Referral and Linkage Billable Activity Example

• Arranging and coordinating adult’s admission to program or service to address identified needs specified in the care plan.

• Preparing Written documentation to offer provider prior to entering service/program.

• Arranging and monitoring the beneficiary’s/client’s access to primary healthcare providers including written correspondence sent to a primary health care provider which gives a synopsis of the past or current treatment that the individual is receiving from other providers

• Referrals to help link the beneficiary/client with medical, social, educational, other providers, programs and/or other services that are needed.

• Follow up with providers to determine whether the services meet the beneficiary’s/client’s needs.

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Referral and Linkage Billable Activity Example

• Follow-up with provider to determine if the services for the beneficiary/client are being received. Staffing with supervisory staff on a specific case to assure target case management. i.e. (when planning to move adult from one treatment program to another, change in treatment provider, change in adult’s CMP)

• Refer client/family to providers to complete disability applications (except Medicaid) TCM activities are only billable when it will assist the beneficiary in gaining access to needed medical, social, educational and other services.

• Referral to service provider to address needs including but not exclusively medical and dental services.

• Calls to potential providers to access the availability of services.

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Referral and Linkage Example Notes

• Contacted SC DMH therapist Cathy Dee to make referral for services.

• Contacted audiologist John James to schedule appointment for adult’s hearing examination to assess clients hearing loss.

• Contacted Alcohol and Drug Commission to schedule evolution for client/beneficiary. Appointment time is 8/3/10 at 1:00 pm.

• Contacted Dr. John James’s office to assure that adult attended scheduled medical appointment.

• Called Dr. M. Monday to schedule psychological evaluation. Appointment scheduled for Tuesday, June 5, 2010.

• Contacted DMH therapist Cathy Dee to verify client’s evaluation appointment date and time.

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Referral and Linkage Example Notes (Cont.)

• Called provider to schedule transportation to SC Vocational Rehabilitation appointment.

• Called and scheduled client’s/ beneficiary’s orthodontist appointment with Dr. Teeth for 6/5/2010.

• Contacted SC@ Private Provider to make referral for meals on wheels.

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Monitoring and Follow-

up

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Monitoring and Follow-

up

• This component includes activities and contacts that are necessary to ensure the CMP is implemented effectively and the needs of the adult are being adequately addressed.

• These activities and contacts may be with the adult, family members, service providers, or other entities.

• Preparation of a written report that details an environmental, emotional status, history, treatment, or progress (other than legal or consultative purposes) for physicians, other service providers or agencies.

Monitoring (Cont.)

• Activities determine: • Whether services are being

furnished in accordance with the CMP.

• Whether the services in the CMP are adequate.

• Whether there are changes in the needs or status of the eligible adult, and if so, making necessary adjustments to the CMP and service arrangements with providers.

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Monitoring and Follow-upAdult Service Specific (continued)

• Staffing with supervisor if there are changes in the needs or status of beneficiary/client, facilitating targeted case management. Only billable when it has been documented that the meeting is related to receiving consultation and supervision on a specific case to facilitate case management which includes recommending and facilitating movement from one program to another or one agency to another.

• Conducting a periodic reassessment to gather and determine beneficiary’s/ client’s needs.

• Documenting a report that details client’s history, current psychiatric status, treatment and progress. TCM will pay for preparation of a written report that details a psychiatric status, history, treatment, or progress (other than legal or consultative purposes) for physicians, other service providers or agencies. TCM will pay when it’s for those providers that are underlined and not for an internal process.

• Contacting providers to obtain information on changes to the beneficiary’s/client’s needs.

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Monitoring and Follow-up Adult Service Specific (continued)

• Accessing information from progress notes to monitor and assure that services are being provided in accordance with the adult’s CMP.

• Gathering information from physician, psychologist, caregiver etc. to complete the reassessment of the beneficiary.

• Documenting information to health care providers to give a summary of services that the Adult is currently receiving.

• Assisting the beneficiary/client in locating or arranging medical services and coordinating needed medical transportation. TCM does not pay for the transportation of beneficiaries.

• Gaining access to needed medical, social, educational and other services.

• Advocating for service provision on behalf of an adult.

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• Staffing with other involved agencies to assure that services being provided are meeting the adult’s needs and furnished in accordance with the CMP.

• Gathering data from adult’s file to prepare written report prior to discharge.

• Reviewing service providers progress notes/treatment plans for the purpose of assessing appropriateness of services and ascertain whether or not services are being furnished in accordance with the CMP.

• Exchange of information with team members (other involved agencies and/or providers).

Monitoring and Follow-upAdult Service Specific (continued)

REMINDER

Allowable TCM activities are those that include assistance in accessing a necessary service, BUT DO NOT INCLUDE THE DIRECT DELIVERY OF THE UNDERLYING SERVICE.

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Activity Notes (AN)

This is a Service Note for Adult Services.

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Why Document?

• In order to be billable, service must be documented in the client’s record.

• Makes information easily available.• Prevents or reduces duplication.• Enables continuity if or when

personnel change.• Provides a snapshot in time that

can be relied upon as proof of service or past events.

• Provides a legal record of services provided to and on the behalf of the adult .

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Documentation Standards

• All information must be completed on the Activity Note.

• Each entry should be completed and signed by the Case Manager at the time an activity is rendered.

• All entries should be written, signed, titled, and dated.

• Must include a description of each specific activity rendered.

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Activity Note

• Activity Notes must be filed in the adult’s record within five (5) business days.

• The Activity (Service) Notes must be completed in CAPSS.

• The Activity Note should provide the reader with a chronological summary of all the activities that address the identified needs of the adult.

• Documentation must be completed for each specific activity rendered to an adult client who receives TCM services through DSS/AS.

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Activity Note: Content

• Who was involved? – Include role of involved

person, i.e., Mrs. Smith daughter, spouse, etc.

• Where did the activity take place?

• When did the activity take place?

• How much time was spent? • What was the purpose of the

activity?• What tasks/activities were

provided?• What was the outcome?

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Activity Notes• Each person referenced in an Activity Note should be identified by

his/her full name and affiliation at least once in the note• All Activity Notes (billable and non-billable) must be thoroughly

completed to include:– Start/end times– Type of Activity– Date of Activity and – Case Managers handwritten signature, title , and date

NOTE: Electronic identifier is accepted when entered in CAPSS

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Activity Note Requirements

• Entries are typed into CAPSS (or handwritten using only blue or black ink).

• All entries must be legible and kept in chronological order.

• Abbreviations and symbols may be used. Each office must maintain a list of abbreviations and symbols used in TCM records. If abbreviation is not on list, then full word(s) must be used with abbreviation in ( ) at least once on the page.

• Entries must be individualized for each adult.

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Service Notes in CAPSS

• Select the place of activity and type of activity in CAPSS

• Enter date of activity in appropriate section

• Enter the amount of time for activity in appropriate section

• You must type: Start time - end time 9:45 - 10:30 in body of not

• Type TCM-yes if this is a TCM billable activity after time period

• Then enter the body of note: I talked with Mrs. Smith’s and her daughter (Sue Haney) at client’s home to assess the care needs of client. Client can not prepare her own meals, she needs help with bathing and in cleaning the house. Etc… Her physician is Dr. Robert Jones with Centa Health on Irby Street in Columbia. Other needs identified for the client with her daughter are …….. Mrs. Smith was having trouble walking today due to her arthritis. Client stated the pain is less in the afternoon and she can usually walk better in the afternoons after the weather warms up. She uses a walker or a cane at times.

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Error Correction

• Draw one line through the error, write “error” to the side, make the correction, initial, and date.

• NO correction fluid (white-out).

• In CAPSS, follow the CAPSS procedures for error corrections.

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Misplaced Entry• If a worker has an entry to enter out

of order, then worker must identify entry as a Misplaced Entry, date entry actually entered, reason out of order: then enter type of activity, date activity delivered, length of activity, begin and end time of activity, the correct information or documentation for the activity; then sign, enter your title and date. (Electronic identifier in CAPSS.)

• Must be completed by CM who rendered the case management activity.

• Must be approved by supervisor via a hard copy of notes in clients physical file prior to entry.

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4 Questions

When you are trying to determine whether the activity is billable, ask yourself these questions about your activity:

1. Am I identifying a problem, need, strength, or resource for the Adult?

2. Am I coordinating a service necessary to meet those needs for the Adult?

3. Am I monitoring the provision of the service to the adult?

4. Is this a billable activity?

If the answer is yes, then you are performing a TCM billable activity. Document it that way.

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Monitoring and Follow-Up Example Notes

a. Contacted therapist John Doe to verify that client attended scheduled individual therapy appointment.

b. Contacted LCS John Doe to give him date and time of client’s

appointment with Dr. Joe Doe. CM assured that transportation would be provided by the facility.

c. Contacted care provider (aka adult day care) to obtain information about whether the services are being furnished according to the CMP.

d. Contacted transportation provider (aka RTA) to assure that transportation will be available for scheduled appointment with therapist John Doe.

e. Staffed case with supervisor to discuss need for change in caregiver or placement disruption.

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Think About:A couple of things to keep in mind when documenting:• Think about a justification of the need for TCM and the activity

provided.• TCM is the process of assessing and/or identifying needs,

planning, arranging or referring and linking to services• TCM is providing ongoing follow-up to ensure that the referred

services continue to be necessary and appropriate

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Medicaid Billable

Activities

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The APS Intake

Recording APS reports

Investigations

Petition to the court for custody

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Billable Activities DO NOT Include:

Medicaid TCM Billable Activities• Assessing and documenting the adult’s need for community

resources and services

• Development of the CMP/Service Plan

• If a new CMP is completed within the required timeframe. (If a new CMP is not completed within the required timeframe, prior to the 365th day of last plan, TCM can not be billed)

• Referrals and related activities to help the adult obtain needed services, such as making referrals to providers for needed services and making appointments for the adult

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TCM Billable Activities (cont.)

• Monitoring/follow-up of identified needs on the CMP which include activities and contacts that are necessary to ensure that the CMP is implemented effectively and is adequate in meeting the needs of the adult.

• Assessing the adult’s functional status and modifying the CMP as needed.

• Assessment and referrals made to resolve any crisis situation resulting from death, separation, divorce, changes in living condition or family structure, etc.

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Community Residential Placement (CRP)

• You can bill for making referrals to community residential providers and coordinating placement arrangements

• Billable activities include:– Staffing with the placement entity– Service planning– Coordinating services– Monitoring the adult’s progress, etc.

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Institute for Mental Disease (IMD)Psychiatric Residential Treatment Facility

(PRTF)

• Can only bill for the last thirty (30) days prior to release or discharge

• Billable activities include staffing prior to placement to assess the needs and functional status of the adult, assessing what needs and services need to be addressed upon return to the community, etc.

• Documentation to verify corresponding activities for case management services (at least one billable service per month)

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You can only bill for these activities if:

• The activities are related to the objectives on the adult’s CMP.

• The time spent in the activity involves face-to-face, telephone, or written communication with an individual with direct involvement in providing or assuring the adult obtains the necessary services.

• The activities are documented in a corresponding Activity (Service) Note in CAPSS.

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TCM NON-BILLABLE ACTIVITIES

• The CMP has not been developed and documented in an Activity (Service) Note.

• The activity being provided is not identified on the CMP (Service Plan in CAPSS).

• The adult is unavailable for a period of more than 30 days (ex. whereabouts unknown).

• The adult enters a local jail/prison, Detention Center.• Errands such as obtaining groceries, picking up medication,

paying bills, etc. performed by CM.

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TCM NON-BILLABLE ACTIVITIES

• For administrative activities: mailing/copying reports, determining Medicaid eligibility

• Intake functions • Investigation activities• For court activities, legal papers • Direct provision of transportation• For time spent placing an adult in an institution, nursing home,

or other residential setting• Attempted phone calls, home visits, face-to-face, etc.

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TCM NON-BILLABLE ACTIVITIES

• Providing activities for or on the behalf of other family members.

• Assisting the adult in obtaining job placement, GED, or tutorial services.

• Direct delivery of the service.

• Verification of Medicaid numbers.

• Utilization review.

• Case management record reviews (of own agency).

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Medicaid Requirements Subject to Recoupment:

(This list is not intended to be all inclusive)

• Activity Note not thoroughly completed with start/end time and/or Case Manager signature, title, and date. Electronic Identifier in CAPSS accepted.

• Activity Note documentation does not support amount of time billed and/or TCM Activity.

• CMP is not thoroughly completed with Case Manager signature, title, and date and/or projected completion dates.

• A new CMP was not completed within 365 days.

• Activity and/or provider is not listed on the CMP.

• There is no Assessment completed.

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Questions?

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