1. Alaska EI/ILP & Medicaid Targeted Case Management
What it is
Why we did it
How it is working
December 5, 2006

2. 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

3. 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

4. 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

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

6. 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

7. 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

8. 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%

9. 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

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

11. 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

12. More Information Jerry Fuller, State Medicaid Director
Erin Kinavey, Alaska Part C Coordinator
Jane Atuk, EI/ILP Program Specialist