Targeted Case Management(TCM).ppt

Targeted Case Management (TCM) Rev Dec. 2008 AGENDA Introductions: DMHAS Staff Why Now? Definition of TCM Coding and Documentation Monitoring Activities Review Handouts Questions Answers WHY NOW? Revenue Budget System of Care Data Integrity Best Practices TCM DATA FLOW CHART All TCM Service data (PNP State-Operated) entered electronically at Provider Level DMHAS OOC Extract TCM data sends electronic file to Collections at DAS (Department of Administrative Services) Collections sends file to the State’s Medicaid claims administrator, (EDS) Electronic Data Systems EDS reports total payments to DSS (Department of Social Services) DSS bills the Federal Centers for Medicare Medicaid Services (CMS) The State General Fund is then reimbursed by CMS by 50% Severe persistent psychiatric illness as evidenced by one or more disorders as defined by the current edition of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association that is of sufficient severity to cause serious functional impairment in any of the following domains: Mental Health TCM Target Population Occupation Social relationships Education Housing Ability to manage tasks of daily living Substance Abuse TCM Target Population Persistent substance dependence as evidenced by one or more of the disorders as defined by the current edition of the DSM and by a history of multiple unsuccessful treatment episodes. TCM Services are the continuum of activities, with or on behalf of a client, concerned with assessment, planning, linking, support and advocacy. TCM services include assisting a client in accessing needed housing, medical, clinical, social, educational, and other services. Definition Definition – Getting a Grip on TCM “CLAMP” – a useful mnemonic tool for remembering TCM eligible services C - Coordinating L - Linking A - Accessing M - Monitoring P - Planning Acceptable Diagno