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The Centers for Medicare & Medicaid Services (CMS) interim final rule with comment period (IFC) implementing section 6052 of the Deficit Reduction Act of 2005 (DRA) clarifies the Medicaid definition of covered case management and targeted case management (TCM) services. The rule includes measures to address concerns about improper billing of non-Medicaid services to the Medicaid program by some States, while also including significant beneficiary protections that ensure comprehensive and coordinated services to meet the needs of beneficiaries. Case management consists of services which help beneficiaries gain access to needed medical, social, educational, and other services. "Targeted" case management services are those aimed specifically at special groups of enrollees such as those with developmental disabilities or chronic mental illness. Widespread improper billing by states of the Medicaid program for services mandated by other programs helped prompt Congress to address the problem in the DRA, which redefined the scope of allowable case management services, strengthened State accountability, and required that CMS issue regulations. See the downloads section below for the following documents: a Case Management Fact Sheet, the Case Management IFC, a Case Management Technical Assistance Tool, TCM Optional Outline, and Moratorium Summary.
Page Last Modified: 08/27/2008 3:39:57 PM
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