Providers

Individuals who may qualify for the TCM Services program include anyone who:

• Was a recent inmate or was involuntarily residing in a jail or state prison;
• Has a chronic or complex physical or behavioral health care need;
• Is 18 years of age and older; and
• Meets Medicaid eligibility requirements.

The targeted case management (TCM) provider must be enrolled as a Michigan Medicaid provider and have the capacity to provide all of the core elements of case management services. The TCM provider may be a:

• Community Mental Health Services Program (CMHSP)
• Federally Qualified Health Center (FQHC)
• Rural Health Center (RHC)
• Tribal Health Center (THC)
• Tribal Federally Qualified Health Center (Tribal FQHC)

The organizations that are qualified to become a TCM provider are not required to do so.

Providers that wish to become a TCM provider are required to sign an attestation document indicating they are able to meet the requirements of the TCM program. This includes having a sufficient number of staff to meet the case management service needs of the target population. If an organization is unable to meet the requirements, then they should not enroll as a TCM provider until they are able to do meet the requirements.

A TCM Team will include the following licensed healthcare professionals:

• Medicaid Enrolled Physician; or
• Non-Physician Practitioner (NPP), such as a:
  • Nurse Practitioner
  • Physician Assistant
  • Clinical Nurse Specialist
• Qualified Case Manager, such as a:
  • Registered Nurse (with at least one year of experience providing community health or case management services)
  • Fully Licensed Clinical Social Worker (with at least one year of experience providing social work or case management services)

  Other members of the team may include the following unlicensed professionals:

  • Community Health Workers (CHW)
  • Peer Support Specialists (PSS)
  • Peer Recovery Coach (PRC)

   

  The Medicaid enrolled physician or the NPP provides general supervision of the qualified case manager. The Medicaid enrolled physician, NPP, and qualified case manager must be licensed by the Michigan Department of Licensing and Regulatory Affairs. The qualified case manager assumes professional responsibility for the services provided by any unlicensed practitioner (e.g. CHW, PSS, PRC, etc.) provided under their supervision and delegation, consistent with applicable state law.

The TCM provider must have:

• Case management experience
• Experience with the target population
• Sufficient number of staff to meet the needs of the target population
• An administrative capacity to ensure quality of services
• A financial management capacity and system that provides a record of services and costs
• The capacity to document and maintain beneficiary case
• The willingness and capabilities to coordinate with the beneficiary’s PCP, MHP, and other providers as applicable
• A health information technology (HIT) record system, policies, procedures, and practices to create, document, execute, and update plans of care for the beneficiary.

Prior to officially being recognized as a TCM provider, an attestation document must be signed by the Michigan Medicaid enrolled provider indicating they are able meet the requirements of the TCM provider qualifications and that they agree to adhere to the TCM policy and all applicable laws. By signing the attestation, the provider is agreeing that they are able to provide all of the core elements of the TCM services.

A copy of the TCM Attestation Agreement may be found on this website.

A provider may become designated as a TCM provider only after the Michigan Department of Health and Human Services (MDHHS) receives the signed attestation. The attestation document may be returned to MDHHS through the “Upload Documents” section of the Community Health Automated Medicaid Processing System (CHAMPS) Provider Enrollment subsystem. 

In-reach is a recommended component of the TCM program where a designated professional from the TCM facility will visit with the beneficiary prior to their release to further discuss the details of the TCM services benefit. During this visit, the TCM provider will have an opportunity to learn more about what the beneficiary’s needs once they are released, and it provides the beneficiary an opportunity to ask questions regarding the benefits of the program. During this time, an initial comprehensive assessment visit with a qualified case manager will be scheduled that will take place following the beneficiary’s release from incarceration. The in-reach visit should occur at least 7-14 calendar days, and no more than 30 calendar days, prior to release.

The in-reach component is not reimbursable per federal rules.

Other similar in-reach initiative projects have been found to significantly reduce recidivism rates, emergency department use, and inpatient hospital visits leading to cost savings based on these preventive measures.

Providers are encouraged to explore available grant programs that may be available to assist in funding pre-release services.

For individuals who were released from jail or prison, the TCM provider may contact MDHHS Provider Support (providersupport@michigan.gov) to end the Medicaid incarceration benefit plan restrictions.

For individuals who were released from jail, the TCM provider may also coordinate with the jail corrections officer to contact the local DHHS office to ensure the Living Arrangement page within Bridges is correctly updated to end the program enrollment type (PET) code of “INC-Jail.”

TCM services are considered complete when the beneficiary:

• Has exceeded the 12-month eligibility time period in the TCM program;
• Has received the allowable number of TCM services;
• No longer meets Medicaid eligibility requirements; or
• Communicates the desire to terminate/refuses TCM services to the TCM provider.

• The beneficiary’s year of services will start over, but the number of services will not.
• The remainder of their monitoring and follow-up visits will not be renewed. That is, the number of services available prior to re-incarceration is what will be available upon the beneficiary’s next release.
• If additional services are needed, the provider must obtain prior authorization before services are rendered.

• Beneficiaries eligible for TCM services will show a current benefit plan of “TCM-INC” in addition to their assigned Medicaid-related benefit plans.
• All claims will be submitted and processed through CHAMPS.
• TCM services are carved out of the MHP’s capitation and are billed and reimburse as a fee-for-service benefit.
• CMHSP providers furnishing TCM services must submit claims in the professional format (e.g. CMS-1500 or HIPAA 5010 837P).
• FQHC, RHC, and THC providers furnishing TCM services must submit claims in the institutional format (e.g. UB-04 or HIPAA 5010 837I).
• All fee-for-service claims billed must include a Medicaid enrolled provider as the rendering provider.
• CCBHCs are reimbursed separately through a prospective payment system methodology.

• One face-to-face visit for the initial comprehensive assessment;
• A maximum of 11 face-to-face and/or non face-to-face monitoring visits; and
• A maximum of 11 face-to-face and/or non face-to-face follow-up (education and supports) visits.