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Targeted Case Management (TCM) Reimbursement for the Alameda County TB Program

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

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Targeted Case Management (TCM) Reimbursement for the Alameda County TB Program

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  1. Targeted Case Management (TCM) Reimbursement for the Alameda County TB Program Jennifer Howser, MSN, PHN, RN Alameda County Health Department TB Control Program

  2. 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

  3. 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)

  4. Why do TCM??? • Reimbursement for services • Quality care for TB clients and their families

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. TCM Does NOT Pay for: • Direct patient care such as TB skin testing, physical assessments, injections, etc. • DOT • Education • Epidemiological Investigation

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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.

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