Medicaid Targeted Case Management (TCM)

PCG Human Services™ has successfully guided and supported agencies through the implementation of Medicaid Targeted Case Management (TCM) service billing. We have also reviewed rate setting methodologies and existing programs. PCG Human Services has successfully managed and maximized TCM service reimbursements for clients including child welfare, juvenile justice, and Medicaid state and local agencies.

PCG Human Services has helped agencies to implement statistical allocation methodologies and time studies (including Random Moment Time Studies (RMTS)) to apportion costs reasonably and accurately so they can identify TCM services costs and other federal revenue sources. Child welfare agencies, for example, require special consideration because TCM services may be provided in conjunction with Title IV-E administrative services. PCG Human Services has expertise in seamlessly managing these separate federal revenue streams to maximize reimbursement while maintaining compliance with federal rules.

The new proposed CMS regulations stipulate several TCM service documentation requirements, including a requirement to bill in 15 minute increments. PCG has expertise conducting case reviews and assisting agencies to assess their TCM services documentation and implement new documentation protocols. PCG Human Services can also assist agencies to develop new information systems to document billable TCM events. PCG Human Services has run billing operations for state agencies and we understand the complexities of documenting valid dates of service and billing Medicaid services using HIPAA formatting electronic transactions.

CMS has begun implementing significant changes to how Medicaid agencies reimburse TCM services. The changes could limit reimbursement for services provided to children, in particular, if the requirements are not carefully reviewed and addressed. The revised rules would have an impact on all current TCM programs and must be addressed as part of future programs. They also impact claiming of case management activities, typically called Administrative Case Management (ACM).

If these proposed rules are implemented, many states will need to reevaluate their TCM programs and Medicaid State Plan Amendments and make changes in order to come into compliance and maintain and maximize revenue.

• PCG Human Services is one of the few firms in the country to have successfully assisted state agencies with receiving approval for State Plan amendments for Medicaid TCM services under Section 1915(g) of the Social Security Act.
• PCG Human Services understands how the proposed regulations impact rate setting, service documentation, and services billing operations

• Massachusetts
  
• Florida
• Colorado