Targeted Case Management

Background:  In 2010, CVT launched an effort to expand billing income, and in particular to fund services provided by social workers/case managers, and explored the possibility of securing contracts for Adult Mental Health Targeted Case Management.  Targeted Case Management (TCM) is a federal program that aims to help people with serious mental health problems stay out of the hospital and function independently.  TCM is managed by states, with individual counties either providing case management services through their own social workers or contracting with third party vendors for specialized and challenging populations such as torture survivors.  TCM services must be provided by a licensed clinician (social worker) and cannot involve psychotherapy.

Eligibility: Eligibility may vary from state to state.  In Minnesota, persons are eligible for TCM if they are eligible for Medicaid, have a mental illness, and meet at least one of the criteria listed below.  CVT has found that 70-75% of clients are eligible by virtue of a diagnosis of major depressive disorder.

1. Two or more episodes of inpatient care for a mental illness within the preceding 24 months;
2. Continuous psychiatric hospitalization or residential treatment exceeding six months duration within the preceding 12 months;
3. Has been treated by a crisis team two or more times within the preceding 24 months;
4. Has a diagnosis of schizophrenia, bipolar disorder, major depression or borderline personality disorder; indicates a significant impairment in functioning; and has a written opinion from a mental health professional, in the last three years, stating that the adult is reasonably likely to have future episodes requiring inpatient or residential treatment, of a frequency described in clause (1) or (2) above, unless ongoing case management or community support services are provided;
5. Has, in the last three years, been committed by a court as a person who is mentally ill under chapter 253B, or the adult’s commitment has been stayed or continued; or
6. Was eligible under clauses (1) to (5), but the specified time period had expired or the adult was eligible as a child; and has a written opinion from a mental health professional, in the last three years, stating that the adult is reasonably likely to have future episodes requiring inpatient or residential treatment, of a frequency described in clause (1) or (2), unless ongoing case management or community support services are provided.

Reimbursement details: Contracts are issued by counties, and the reimbursement rate is negotiated between the county and the third party vendor.  CVT’s rate is $530 per client per month, and reimbursements are made by the state Department of Human Services.  For example, if 10 clients are TCM-eligible, the monthly reimbursement for those clients would be $5,300 and the annual reimbursement would be $63,600.

There are several parts to the process of launching TCM: a political process that involves relationship-building with county commissioners and professional health and human services staff, to help secure a contract with the county; an internal clinical process of altering the social services/case management function to conform to TCM requirements and then training case managers on the new requirements;  and a financial/administrative process to facilitate billing if that capability doesn’t already exist and to align with TCM billing requirements.

To begin the contracting process, it is vital to establish relationships with the county officials, mentioned above, who represent the district where your torture rehabilitation program is located.