Targeted Case Management TCM Reimbursement for the Alameda County TB Program

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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

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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

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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)

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Why do TCM???

• Reimbursement for services
• Quality care for TB clients and their families

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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

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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

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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

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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

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Billable TCM Encounter Examples

• A case manager visits a TB client face to face
  and 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

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TCM Does NOT Pay for

• Direct patient care such as TB skin testing,
  physical assessments, injections, etc.
• DOT
• Education
• Epidemiological Investigation

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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

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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

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Alameda Countys 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

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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

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Example of TCM ComponentAssistance 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

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Example of TCM ComponentLinkage 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

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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 countys
  MAA/TCM LGA Coordinator

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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 theres a link from the TCM home
  page www.dhs.ca.gov/tcm
• For a list of LGA MAA/TCM coordinators by
  jurisdiction (its the same person in every
  jurisdiction) go to www.maa-tcm.net.
• The list is under the Contacts link.