MR/ID Targeted Case Management Service Definition and Eligibility Requirements

Service Definition

All individuals receiving MR/ID Waiver services must receive MR/ID Targeted Case Management Services. MR/ID Targeted Case Management Services covered under the Medicaid Program do not require preauthorization. The case management provider must meet all applicable standards and policies. It is the responsibility of the CSB/BHA to assure individuals’ ongoing eligibility and need for MR/ID Targeted Case Management Services.

Criteria

The assigned case manager must provide MR/ID Targeted Case Management Services as frequently and timely as the person needs assistance. There must be at least one documented contact, activity, or communication, as designated above, and relevant to the Individual Support Plan, during any calendar month for which MR/ID Targeted Case Management services are billed.

The activity of writing the Individual Support Plan, person-centered review, or case note is not considered a billable case management activity. Developing the Individual Support Plan through a team meeting or reviewing other providers’ written materials in order to prepare the case management person-centered reviews are billable activities.

Accompanying individuals to appointments or transporting them is not covered. MR/ID Targeted Case Management Services may be provided to an individual who is eligible for Medicaid benefits and who is documented to have MR/ID as defined by the AAIDD.

Individuals with MR/ID and children less than six years of age who are at developmental risk and who are receiving MR/ID Waiver Services are eligible for and must also be receiving MR/ID Targeted Case Management Services during the months that MR/ID Waiver services are received.

To be eligible to receive MR/ID Targeted Case Management Services, the individual must need "active case management." An individual is considered to need "active case management" if a minimum of one face-to-face contact is required every 90 days. In addition, a minimum of one scheduled or unscheduled contact or communication by the case manager per month with the individual or with the family, service providers, or other organizations on behalf of the individual must typically be performed. The contact must be relevant to the individual’s needs and Individual Support Plan.