1. Targeted Case Management
GUIDELINES, DOCUMENTATION,
AND BILLING
PRESENTED BY:
THE DEPARTMENT OF HEALTH CARE
POLICY AND FINANCING
AND
THE DIVISION FOR DEVELOPMENTAL DISABILITIES

2. Background Designated by Waiver Case Management in Colorado
Administrative Case Management
Case Management as a Waiver Service
Targeted Case Management
Designated by Waiver

3. Overview State Plan Benefit Targeted Population Entitlement Benefit
Persons with Developmental Disabilities; and
Enrolled HCBS-DD, SLS, or CES; or
Enrolled in Early Intervention Services; and
Medicaid Eligible

4. CMS Assurances The State Assures that:
Clients will have free choice of providers
Case management services will be provided in a manner consistent with the client’s best interest
Case management services will not be used to restrict a client’s access to other services
Clients will not be compelled to receive case management services
Case managers cannot authorize or deny other State Plan services

5. Qualified Providers Community Centered Boards Case Managers
Only legally authorized agencies to provide TCM to individuals with DD in community settings
Case Managers
Appropriate qualifications to provide TCM
Bachelor’s Degree,
Five years experience in the field of developmental disabilities, OR
Some combination of education and experience

6. Purpose Facilitate Enrollment Service Plan Development
Service Monitoring
Effective
Efficient
Coordination of Services/Benefits
Educational
Mental Health
Emotional
Social
Medical
Ensure Non Duplication of Services

7. Reimbursement CMS Compliant HSRI Findings Audits Billing Codes
15 Minute Increments
CMS Compliant
HSRI Findings
Audits
Billing Codes

8. Reimbursement Specifically Defined Activity and Purposeful Outcome
Example: Telephone contact to
schedule IDT Meeting
Bill in 15 minute increments
1-15 minutes = 15 minutes
Continuous Activity with Separate
tasks
Example: Record Review, Telephone
Contact, Service Plan Revision
Bill Total Time Spent
State of Colorado

9. Reimbursement Multiple Client Contact Multiple Contacts – One Day
Example: Monitoring Visit with
4 Clients at the same Group Home
Estimate time/unit per individual
Multiple Contacts – One Day
Example: Client calls 10 times in
one day
Professional Judgment
Number of units billed should not exceed total amount of time worked.
State of Colorado

10. General Contacts Direct Contacts Indirect Contacts Face-to-Face Email
Correspondence
Indirect Contacts
Consultation with supervisor for the purpose to plan or coordinate need services
Documentation of TCM Activities
Documentation and Review of Documentation for the purpose of the individual record
Review and distribution of records for planning, coordinating, assessing, and referral to services.

11. Billable Activities Comprehensive Assessment and Periodic Reassessment
Determine need for:
Medical, Educational, Social, Other Services
Examples:
Client History
Assist in accessing benefits e.g., Social Security and/or Medicaid re-determination
Obtain and review any relevant and/or required assessments needed for service planning

12. Billable Activities Service Plan Development
Based on information collected through assessment
Specifies goals for meeting all service needs
Medical
Social
Educational
Other Services
Activities to ensure client participation
Work with individual and others to develop goals
Identifies course of action

13. Billable Activities Service and Support Coordination
Coordination of the services being provided in the Service Plan to ensure continuity of service provision
Referral and Related Activities
Help individual obtain needed services and activities and link them to the appropriate provider:
Medical
Social
Educational
Other Programs

14. Billable Activities Monitoring and Follow Up Activities Services are:
Implemented and delivered according to Service Plan
Adequately meeting the individual’s need
Monitor changes in need
Make necessary changes/revisions
Provide Notification

15. Billable Activities Monitoring and Follow Up Activities cont.
Health & safety needs are met
Rights are respected
Client Satisfaction

16. Administrative Activities
Intake and Eligibility Determination
Reporting and Aggregating Data
Critical Incidents
Complaints
Agency Meetings
Case Management/Staff
Training
Professional Developmental
Utilization Review
ULTC 100.2
SIS

17. Benefits Utilization System
Documentation
Benefits Utilization System
If it didn’t happen on the BUS, it didn’t happen . . .

18. Benefits Utilization System
Documentation
Reimbursement based on BUS Documentation
Log notes document units
Reports generated by the BUS
Support claims paid
Benefits Utilization System
If it didn’t happen on the BUS, it didn’t happen . . .

19. Documentation Date Time Units Drop Down Menu 15 Minute Increments
The BUS will generate a date and time of entry
CM should reflect within the log note the date/time of the activity noted
Time
Record when appropriate
Pertinent to the activity
Units
Drop Down Menu
15 Minute Increments
Record Units up to 32 Units (8 Hours)

20. Activity Documentation TCM activity that is being performed
Multiple related activities or activities performed within a single day may be entered into a single log note
Must be a billable activity
Type of contact
Direct
Indirect

21. Documentation Finding Follow Up Action
The observations, assessments, or outcomes of the activity.
Follow Up Action
The actions to be taken with the information obtained from the activity
When appropriate 

22. Appropriation Ethical and Professional Reporting Considerations
Budget Neutrality

23. Questions?