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) Lead Agency is Department of Health and Social Services Provider agencies are grantees of DHSS, compliance assured through grant agreements Family service coordination (FSC) by direct service providers, usually employees of grantee agencies

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

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

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

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

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

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

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

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

TCM Pilot Project – Phase II Ongoing Process Improvement Documentation Ongoing Evaluation Processes: efficient and effective “Clean Claims” – high percentage Cost / benefit analysis Impact on children/families/programs

More Information Jerry Fuller, State Medicaid Director Jerry_Fuller@health.state.ak.us Erin Kinavey, Alaska Part C Coordinator Erin_Kinavey@health.state.ak.us Jane Atuk, EI/ILP Program Specialist Jane_Atuk@health.state.ak.us