Alaska EI/ILP & Medicaid Targeted Case Management

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 ManagementGeneral 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 ManagementGeneral 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 ManagementGeneral 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 ManagementGeneral Policy Description May bill the monthly rate after minimum of one documented qualifying case management contact in a month Onecharge 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

Alaska EI/ILP & Medicaid Targeted Case Management