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Targeted Case Management - Recuperative Care

Targeted Case Management - Recuperative Care

Targeted Case Management (TCM) - Recuperative Care (RC) is a transitional program for Medicaid beneficiaries meeting eligibility requirements who are experiencing homelessness and discharging from an inpatient hospital admission. Beneficiaries are too ill or frail to return to their living environment, but are not eligible to continue hospital-level care, skilled nursing care, or other inpatient Medicaid services. RC is a short-term program that allows these beneficiaries to recover post-hospitalization, receive case management services, access medical care or other Medicaid services, and receive supportive services. 

The information on this page serves as a reference only. It does not guarantee that services are covered. Providers are instructed to refer to the Michigan Medicaid Provider Manual, MMP Bulletins and other relevant policy for specific coverage and reimbursement policies. This information can be found on the Medicaid Policy, Letters & Forms web page. If there are discrepancies between the information on this page and the Provider Manual, such as rate or coverage determinations, they will be resolved in favor of the Provider Manual language.

Refer to the Medicaid Provider Forms and Other Resources web page for copies of the following forms:

  • BPHASA-2427 - Recuperative Care Prior Authorization Request Data
  • BPHASA-2428 - Michigan Recuperative Care Provider Attestation

Recuperative Care Fee Database

The professional fee schedule format lists procedure codes, descriptions, and fee screens. The modifier and age range fields are applicable to the fee screen and do not reflect coverage parameters. For additional pertinent coverage parameters, such as documentation and billing indicators, refer to the Medicaid Code and Rate Reference tool, which is accessible via the External Links menu within CHAMPS. Medicaid Code and Rate Reference is an online code inquiry system that provides real-time information for the following:

  • Age restrictions,
  • Diagnoses allowable for Ambulance,
  • Documentation requirements,
  • Frequency limitations,
  • Hospital discharge - Bypass PA
  • NDC information,
  • Prior authorizations and medical conditions that may bypass these requirements,
  • Rate information,
  • Required modifiers,
  • Supplies/DME - per diem, and
  • Tooth number and surface requirements.

To request or view upcoming training sessions please refer to the Michigan Department of Health and Human Services website at www.michigan.gov/medicaidproviders >> Training >> Medicaid Provider Training Sessions.

Any questions should be directed to Provider Inquiry, Michigan Department of Health and Human Services, phone toll-free 1-800-292-2550 or email at providersupport@michigan.gov.