Medicaid Billing Module Targeted Case Management TCM Billing

Medicaid Billing Module Targeted Case Management (TCM) Billing Form

Changes • Targeted Case Management (TCM) can only be billed for students getting billable services based upon medical necessity. • An SLD student who doesn’t have speech, OT, PT, Nursing, psychotherapy, behavior intervention would not be eligible for TCM • Can be billed by multiple providers, but should be coordinated by one person.

Targeted Case Management • TCM is capped as five units per instructional day. • TCM can be billed on days the student is absent.

Demographics • Complete the sections with attention to the following: • Diagnosis code should not be based on an educational disability such as Learning Disability. Example would be an LD student with speech as a related service, use the speech diagnosis code.

Approved Activity List • Has been re-organized into four major categories. • A – Needs Assessment and Reassessment • B – Development/Revision of Service Plan • C – Referral and Related Services • D – Monitoring and Follow-up

Assessment Activities • Assess/Reassess student • Assessed the student's ability to interact and socialize with peers in the general setting • Assessed the student's modifications/accommodations • Assessed/Reviewed student's assessment and discipline data • Assessed current progress notes/therapy logs • Conducted an assessment of the student's needs in regards to hygiene and independence

Assessment Activities Continued • Conducted a student behavioral assessment for behavioral health concerns. • Conducted review of student's progress with Medicaid covered services • Gathered analyzed behavioral data on student's target behaviors included in the behavior intervention plan • Gathered information from the student's records and from Medicaid service providers • Reviewed documentation from outside agencies such as physicians, psychologists, audiologists

Development of Service Plan Activities • Conducted revision of plan • Develop a "draft" Service Plan that incorporated strengths and weaknesses along with modifications/accommodations • Developed a home communication plan based on medical needs (behavior)

Referral and Related Service Activities • Advocated with outside non-school therapy provider • Advocated for the student with administration • Assisted family with application for outside supports • Consulted/met with County or School Administrator • Consulted/met with Occupational Therapist • Consulted with outside medical provider

Referral and Related Service Activities • • Consulted/met with Parent/Guardian Consulted/met with Personal Care Aide Consulted/met with Physical Therapist Consulted/met with Psychologist or other Mental Health Provider • Consulted/met with School Counselor • Consulted/met with Nurse

Referral and Related Service Activities • Consulted/met with Speech Therapist • Consulted/met with Teacher (General or Special Ed) teachers • Reviewed the student's Behavior Intervention Plan and Crisis Response procedures with school staff • Arrange/assess for the student to have calming strategies included in the student's behavior intervention plan and sensory diet.

Referral and Related Service Activities • Consult with crisis team • Provided Intervention by implementing CPI techniques in response to crisis • Provided intervention according to behavior intervention plan (described below) • Worked with crisis team

Monitoring and Follow-Up Activities • Monitored behavioral health needs through the development of progress notes that are sent home to parents • Followed up on the student's behavior referrals towards meeting goals • Followed up on the student's Medicaid related services • Followed up on the student's previous involvement in an incident as part of follow up activities when CPI is used

TCM Purposes • Access travel to Medicaid covered services in community • Assistance for related therapies • Assist the student in accessing medical services • Assure student receives appropriate action as medically necessary • Complete correspondence with agency outside of school to participate in developing plan. • Complete at-risk referral.

TCM Purposes • Coordinate and provide a continuity of services. • Determine an appropriate Behavior Intervention Plan as it relates to medically necessary services. • Assess if target behaviors are being generalized in the home environment • Assess if target behavior skills are being generalized in the school environment. • Assess if target communication skills are being generalized in the school environment • Assess if target communication skills are being generalized in the home environment.

TCM Purposes • Assess the student's communication skills in all settings. • Develop a Behavior Intervention Plan as medically necessary • Develop a Behavior Intervention Plan and Crisis Response procedures • Assess the response to the crisis • Assess/reassess progress and generalization of Medicaid related services • Monitor and follow up that adequate Crisis Response procedures are followed.

TCM Purposes • Facilitate communication with parents of progress with student Medicaid related services • Advocate behavioral intervention. • Advocate counseling services. • Advocate nursing services. • Advocate psychological services.

TCM Purposes • Advocate speech services. • Advocate needed support to access general education, cafeteria, bathroom and auditorium • Recommend behavior interventionist to assist student in developing coping skills for behavioral issues • Review of Functional Behavior Assessment results • Related to the student's medical services/needs necessary for the development of a Health Care Plan.

Individual Service Note • For each entry add an individual service note. • Include the student name to personalize the note. Example: Met with Jane’s classroom teacher to determine how she is generalizing speech in classroom setting • This is a brief description of what was done.

Documentation • For each service list: – Date of service – Type of contact (1. Face to Face, 2. Correspondence, 3. Telephone Contact) – TCM Activity Type – Start Time – Stop Time – Total Minutes

Documentation • Choose an activity from the drop down list • Choose a purpose from the drop down list • Write a personalized brief note of what occurred • Sign and list credentials • Date signature

Accumulation of Minutes • A TCM unit can be obtaining by adding minutes across multiple days. • Minutes must be from the same month. • Minutes do not have to be on consecutive instructional days. • If doing multiple day unit list the date of service as the day the 15 th minute was provided.

Accumulation of Minutes • If accumulating minutes on a regular schedule for the exact same type of activity such as 2: 50 -2: 55 for “Provided intervention according to behavior intervention plan” you may use one entry and document the three dates involved in the unit. • If the accumulating minutes are for different activities the minutes for partial units would need documented on a separate section of the form.

Terry Riley – Coordinator Office of Special Education tjriley@k 12. wv. us 304 -957 -9833 ext 53223 WVDE Medicaid Website: http: //wvde. state. wv. us/osp/medicaid. html