Ky.gov
Effective: 10/15/2024

G1.10 Targeted Case Management: TCM Contacts with a Family

Legal Authority

Introduction

​​​​​​​​​​​​Targeted Case Management (TCM) services are provided by qualified Department for Community Based Services  (DCBS) staff who appropriately document the delivery of a Medicaid-covered TCM service.

TCM services are provided to Medicaid eligible clients who are:

  • Children aged zero (0) through twenty (20) who meet the conditions and circumstances to be defined as a child in the custody of or at risk of being in the custody of the Cabinet for Health and Family Services (CHFS/Cabinet); or
  • Adults age twenty-one (21) or older who meet the conditions and circumstances to be defined as an adult in need of protective services.

All TCM documentation is the property of Medicaid and as such, both the government of the United States and the Commonwealth of Kentucky may audit all claims and substantiating records. All records are subject to post-payment review and are maintained for a minimum of five (5) years.


Practice Guidance

  • A qualified case manager meets the following minimum qualifications:
    • A Bachelor of Arts or Bachelor of Science degree in any of the social/behavioral sciences or related fields from an accredited institution; and
    • One (1) year of post-bachelor experience working directly with the targeted population or performing case management services;1 
  • Only the qualified case manager of record may enter documentation for TCM services.

  • TWIST documentation requires that the individual client:
    • Has a valid Social Security number (SSN), which is matched in Kentucky Automated Management Eligibility (KAMES) (the matching is done automatically by TWIST);
    • Has a correct date of birth (DOB);
    • Has an address entered in “Present Location;” and
    • Is listed in the “On Behalf Of” box in TWIST.
  • TCM services are those that will assist the targeted population in gaining needed medical, educational, social, and other support services.  These services include:
    • A written comprehensive ongoing assessment, which has face-to-face contact with the child, adult, his family, or other collateral needed to determine the individual’s needs;
    • Participation in the development of the individual’s case plan;
    • Coordination of and arranging for needed services as identified in the individual’s case plan;
    • Assisting the individual and his family or person in custodial control in accessing needed services (both Medicaid or non-medical) as provided by a multiplicity of agencies and programs;
    • Monitoring the individual’s progress through the full array of services by:
      • Making referrals;
      • Tracking the individual’s appointments;
      • Removing barriers that prohibit access to the recommended programs or services;
      • Performing follow-up on services rendered to ensure the services are received and meet the individual’s needs; A Master’s degree in a human service field can substitute for one (1) year experience.
      • Performing periodic re-assessments of the individual's changing needs; and/or
      • Educating the family or individual on the value of early intervention services and treatment programs;
    • Performing advocacy activities on behalf of the individual. The case manager may intercede to ensure appropriate, timely, and productive treatment modalities;
    • Establishing and maintaining current client records, documenting contacts, services needed, client’s progress, and any other information as may be required;
    • Providing case consultation as required (i.e. consulting with a  service provider to assist in determining the individual’s  progress, etc.); and
    • Providing crisis assistance (i.e. intervention on behalf of the individual, making arrangements for emergency referrals and treatment, and coordinating any other needed emergency services).
    • Agency services not coded to TCM include:
      • Investigations and ​​FINSAs;
      • Domestic violence cases;
      • The actual provision of treatment;
      • Outreach activities to potential clients;
      • Direct services (parenting training, foster parent training);
      • Social work counseling:
      • Administrative activities associated with Medicaid eligibility determinations, application processing, etc.;
      • Institution discharge planning, such as a hospital or nursing facility, as these facilities are required to provide this service as a condition of payment. The case manager may bill, however, for services performed either in the month before or the month of discharge from the facility to prepare the individual’s return to the community;
      • Transportation services regardless of the reason for the transport; and
      • Duplication of payments to public agencies or private entities under other program authorities for the same purpose.

    Procedure

    The qualified case manager

    1. Enters TCM contacts only for those cases where the case manager:
      1. Meets Medicaid eligibility requirements; and
      2. Provides valid TCM services;
    2. Ensures that the following words are entered into each TCM contact: "DCBS has chosen to bill TCM for case management activities, related to (add one of the following codes)":
      1. Assessing individual needs;
      2. Arranging services;
      3. Assisting in accessing services;
      4. Tracking cases for progress;
      5. Advocating for an individual;
      6. Consulting on a case; or
      7. Crisis assistance in an emergency situation;
    3. Enters the following in TWIST:
      1. The eligible individual(s);
      2. The exact contact date;
      3. The contact location, must be one of the following:
        1. School;
        2. Daycare;
        3. Office;
        4. Home;
        5. Child/youth placement;
        6. Jail/detention; or
        7. Adult living location;
      4. The contact type;
      5. The purpose of contact; and
      6. One (1) of the following service activities:
        1. TCM Advocacy;
        2. TCM Arranging Delivery of Services;
        3. TCM Assessing Needs;​
        4. TCM Assist Access of Needed Services;
        5. TCM Case Consultation;
        6. TCM Crisis Assistance; or
        7. TCM Tracking Referral, Follow-up;
    4. Ensures that the contact comments are concise, professional and pertain to the goals established for the child/family and documents the delivery of a covered TCM service as referenced in procedure #2(f);
    5. Selects “Face to Face Worker Initiated Negative” or “Telephone Initiated by Worker Negative” in instances where a face-to-face or telephone contact was initiated and no one was home or answered the telephone;
    6. Does not document contacts that are unsuccessfully completed as a TCM.​



    ​Footnotes​

    1. A Master’s degree in a human service field can substitute for the one (1) year experience.

    Documents

    Revisions