Alaska EIILP Medicaid Targeted Case Management What it

EI/ILP (Alaska’s Part C Program) n Lead Agency is Department of Health and Social

Medicaid Targeted Case Management n Service category available for Medicaid recipients n “Targeted” means

Medicaid Targeted Case Management n Medicaid State Plan Amendment approval n Describes target population

Medicaid Targeted Case Management n. Payment Methodology n. Rate Based on Real Costs n.

Targeted Case Management General Policy Description n Follows all applicable state, federal laws and

Targeted Case Management General Policy Description n Grantees are qualified providers n Billing receipts

Targeted Case Management General Policy Description n Children must be Medicaid eligible to bill

Targeted Case Management General Policy Description May bill the monthly rate after minimum of

TCM Pilot Project – Phase I n Enrollment Process n Outreach Connections/Activities n Successfully

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Alaska EI/ILP & Medicaid Targeted Case Management What it is Why we did it How it is working December 5, 2006

EI/ILP (Alaska’s Part C Program) n Lead Agency is Department of Health and Social Services n Provider agencies are grantees of DHSS, compliance assured through grant agreements n Family service coordination (FSC) by direct service providers, usually employees of grantee agencies 2

Medicaid Targeted Case Management n Service category available for Medicaid recipients n “Targeted” means case management for a specific population n “Case Management“ services assist eligibles to gain access to needed medical, social, education, and other services 3

Medicaid Targeted Case Management n Medicaid State Plan Amendment approval n Describes target population n Outlines billable activity descriptions n Defines provider qualifications n Provides assurances to CMS n Outlines Payment Methodology 4

Medicaid Targeted Case Management n. Payment Methodology n. Rate Based on Real Costs n. Monthly Encounter Rate n. Adjusted annually for inflation n. Approximately $245/month/child 5

Targeted Case Management General Policy Description n Follows all applicable state, federal laws and regulations n Designed to align with current EI/ILP practices (TCM = FSC) n Administrative simplicity n Intra-departmental communication 6

Targeted Case Management General Policy Description n Grantees are qualified providers n Billing receipts = grant income; must be used to further grant objectives n Qualified providers must enroll with Medicaid n Unique Provider ID needed to bill for TCM 7

Targeted Case Management General Policy Description n Children must be Medicaid eligible to bill for TCM n Title XIX or Title XXI (Denali Kid. Care) n Statewide eligibility rate is 30 -35% n EI/ILP Medicaid eligibility rate is 55 -60% 8

Targeted Case Management General Policy Description May bill the monthly rate after minimum of one documented qualifying case management contact in a month One charge per month per child = 12 monthly charges / child/ 12 -month period maximum 9

TCM Pilot Project – Phase I n Enrollment Process n Outreach Connections/Activities n Successfully Identify Qualifying Activities n Documentation Standards and Methods n Recordkeeping / Billing Mechanisms in place 10