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Child Welfare Targeted Case Management (CW-TCM)

Revised: 07-17-2017

  • Overview
  • Eligible Provider
  • Case Manager Qualifications
  • Contracting with Qualified Vendors
  • Eligible Recipient
  • Covered Services
  • CW-TCM Activities and Services
  • Dual Case Management
  • Nonduplication of CW-TCM Services When Client is a Tribal Member
  • Non-Duplication of CW-TCM Services by a County Agency and Its Contracted Vendor
  • Documentation of CW-TCM Services When Dual Case Management is Needed
  • Case Plan-Dual Case Management
  • Contact and Case Notes
  • Noncovered Services
  • Authorization Requirements
  • Billing
  • Legal References
  • Overview

    Child Welfare Targeted Case Management (CW-TCM) activities coordinate social and other services designed to help the child under 21 years old and the child's family gain access to needed social services, mental health services, habilitative services, educational services, health services, vocational services, recreational services and related services including, but not limited to, volunteer services, advocacy, transportation and legal services.

    Case management services include developing an individual service plan, helping the child and child's family obtain needed services through coordination with other agencies, and assuring continuity of care. Case managers must assess the delivery, appropriateness and effectiveness of services on a regular basis. (Minnesota Statutes § 256B.094, subd. 1)

    Eligible Providers

    The Minnesota Department of Human Services (DHS) must certify county and tribal social service agencies for the agencies to receive Medical Assistance (MA) reimbursement for CW-TCM. To become certified, these agencies apply to DHS. A certified provider may contract with a qualified vendor to provide the case management services to clients referred by the certified provider.

    Case Manager Qualifications

    Case managers must be employed by a certified CW-TCM provider or a qualified vendor contracting with a certified CW-TCM provider to provide CW-TCM services and must meet all of the following:

  • • Be skilled in the process of identifying and assessing a wide range of children's needs
  • • Be knowledgeable about local community resources and how to use these resources for the benefits of the child
  • • Hold a bachelor's degree in any of the following:
  • • Social work, psychology, sociology or a closely related field from an accredited four year college or university
  • • A field other than social work, psychology, sociology or closely related field, plus one year of supervised experience in the delivery of social services to children as a social worker in a public or private social services agency
  • Beginning July 2004, federally recognized tribal governments within Minnesota may authorize individuals to serve as tribal child welfare case managers pursuant to MN Statutes 256B.02, subdivision 7, paragraph (c), and determined as meeting applicable standards (MN Statutes § 256F.10, subd. 5).

    Contracting with Qualified Vendors

    County and tribal social services agencies may contract with qualified vendors to provide CW-TCM services for their clients. The following requirements apply:

  • • Contracting agency must negotiate a monthly rate with the vendor that is less than or equal to what the vendor would charge other payers for the same service. DHS must review and approve the contract
  • • Contracting agency is responsible for determining the client’s eligibility to receive the service
  • • Contracting agency is responsible for training the vendor regarding the statutory requirements for documenting and claiming for service reimbursement
  • • Contracting agency is liable for all activities and services provided by the vendor
  • • Contracting agency is responsible for the non-federal share of the vendor’s fee unless another entity has the financial responsibility for services provided to the client and the agency made appropriate arrangements before providing the service
  • • A qualified vendor must enroll as an MHCP provider to be able to claim for CW-TCM services
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    Eligible Recipients

    Children under the age of 21 on MA or MinnesotaCare who meet one of the following criteria:

  • • At risk of out-of-home placement or in placement as defined in Minnesota Statutes 260C.212, subd. 1r
  • • At risk of maltreatment or experiencing maltreatment as defined in Minnesota Statutes 626.556, subd. 10e
  • • In need of protection or services as defined in Minnesota Statutes 260C.007, subd. 6
  • Children who are developmentally disabled are not automatically eligible for CW-TCM services. They must meet one of the above criteria to be eligible to receive services.

    The county agency responsible for child welfare services must make this determination. The activities involved in the determination of eligibility are not claimable as CW-TCM. Submit a CW-TCM claim only after recording in the case file the determination of eligibility for CW-TCM services, the case finding (including a brief description of the circumstances that support the finding), and case plan.

    A child who meets the eligibility criteria for both CW-TCM and MH-TCM may receive both services from the same agency and the agency may claim both services in the same month as appropriate. The two services must be distinctly different for an agency to claim the services in the same month.

    Covered Services

    CW-TCM Activities and Services

    Case management activities are those that help the eligible recipient gain access to needed medical, social, educational and other services as identified in an individual service plan. Only services delivered on a face-to-face basis are claimable as CW-TCM unless the client is in placement more than 60 miles beyond county or reservation boundaries. In such a case, a provider may submit a claim for a telephone contact in two consecutive months. There must be a face-to-face contact in the month preceding the eligible telephone contacts. Examples of CW-TCM activities include, but are not limited to the following:

  • • Assessment of the recipient's need for case management services to gain access to medical, social, educational and other related services
  • • The development, completion and regular review of a written individual case plan based on the assessment of need for case management services
  • • Routine contact or other communication with the recipient, the recipient's family, primary caregiver, legal representative, substitute care provider, service providers or other relevant people identified as necessary to the development or implementation of the goals of the individual case plan
  • • Coordinating referrals and providing case management services for the recipient with appropriate service providers, consistent with section 1902(a)(23) of the Social Security Act (free choice of provider)
  • • Coordinating with the MA facility discharge planner in the 30-day period prior to the recipient's discharge into the community (this is the only claimable CW-TCM service provided to patients or residents in an MA-funded facility and is limited to a maximum of two 30-day periods per calendar year)
  • • Coordinating and monitoring the overall service delivery to ensure quality of services
  • • Monitoring and evaluating services on a regular basis to ensure appropriateness and continued need
  • • Completing and maintaining necessary documentation that supports and verifies the CW-TCM activities
  • Documentation of CW-TCM Services
    CW-TCM is child-specific. Therefore, each child must have his or her own case file, even though the documentation may also be part of an existing family case file. The following information must be in each child’s case file:

  • • Case number, client identification, client name and client date of birth
  • • The assessment of eligibility to receive CW-TCM services
  • • The determination that the child is eligible to receive CW-TCM services. It must contain a written description of the child’s or family’s situation and which condition of eligibility the child meets
  • • The case finding
  • • A statement that identifies that case management is necessary and the child will receive CW-TCM. This statement describes the circumstances that support the child’s need for CW-TCM services. (Sample assessment and case finding: Janie is in need of protective services because of _____________ and will receive CW-TCM services.)
  • Case Plan
    Providers may incorporate case plans for CW-TCM into other plans such as child protection plans, family service plans, out-of-home placement plans, etc., but the portion of the plan that pertains to CW-TCM needs to be clearly identified. The CW-TCM plan must be child-specific for each child in the family that qualifies for the service. Children’s needs vary and providers need to acknowledge that on an individual basis. If a family plan is used, address each individual’s needs, as well as the needs of the family as a whole.

    Case plans must describe the services the client needs to help achieve the goals of the case plan and how the case manager will help the client access these services. If more than one case manager will work with the family, document the justification for dual case management and the distinct role each case manager will fill.

    In situations where case managers from more than one agency are working with the family, the case managers must develop case plans jointly or in coordination with each other and each case manager will have a copy of the resulting case plan in the file. If case managers develop case plans individually, they must exchange plans and amend their plans as appropriate.

    For convenience, attach or include with the case plan a family and collateral contact list. Include on the contact list all family members and other people integral to achieving the goals of the case plan and the name and relationship to the client of each person. This will eliminate the need to mention the relationship each time you refer to that person in the case or contact notes.

    Those responsible for their success should sign the case plans. This may include parents, guardians, case managers, children, etc. Whoever any revisions most affect must initial the revisions, when possible.

    While statutory language requires only an annual review of the case plan, more frequent review and revision are often necessary to keep the case plan current and relevant.

    Contact and Case Notes
    The following information describes the types of activities that must be included in the contact and case notes to constitute a billable event.

    Case management services include the following:

  • • Developing an individual service plan
  • • Helping the child and the child’s family obtain needed services through coordination with other agencies
  • • Assuring continuity of care between agencies
  • Case managers must assess the delivery, appropriateness and effectiveness of services on a regular basis. (Minnesota Statutes 256B.094, subd. 1.)

    Contact or case notes need to include the who, what, when, where and why of the contact, including the following:

  • • The relationship of the person you contact to the client, unless this information is included elsewhere in the case file
  • • The name of the person making the contact
  • • The date (including the year)
  • • The signature of the person writing the note
  • Dual Case Management

    Most children who receive CW-TCM services need only one case manager. However, at times a child will require services from both the county social services agency and a tribal agency or the agency’s qualified contracted vendor. When this occurs, do not duplicate services because federal regulations prohibit Medicaid from paying for duplicate services.

    The two agencies must notify each other and coordinate the services they provide. They must have written documentation of the reasons for dual case management and the services each agency will provide in enough detail that it leaves no question about the need for services from each agency and that the agencies are providing different services.

    Nonduplication of CW-TCM Services When Client is a Tribal Member

    The Minnesota Tribal/State Agreement (PDF) states that tribes have jurisdiction over any child custody proceeding concerning an Indian child, with few exceptions. The burden of assuring that the county is not duplicating services the tribal social services agency is providing rests with the county. If the tribal capacity to provide needed services is limited, or the tribe and the county agree that the county will provide certain services, it is the responsibility of the county to deliver necessary case management services. The tribal case manager may refer the client or family to the county for county-provided services other than CW-TCM.

    The tribal workers might also assess a need for additional services not specified by the court and available from tribal agencies, and would help the family access these services. The county has the responsibility of enforcing the orders of the county court and facilitating access to those services available from the county.

    Examples of considerations to determine when dual case management is necessary and appropriate for a client who is a tribal member include the following:

  • • Does state or federal law require involvement of both the tribe and the county to provide child welfare or child protection services to the client?
  • • What are the needs of the client and his or her family? Will you need to refer the client or family to the county for services such as family preservation services, chemical dependency (CD) services, etc.?
  • • Will a single case manager from the tribal agency meet the client’s needs, or will the client also need the services of a county case manager (not county services, but actual case management)?
  • • Does a court order exist that requires the county to be responsible for the execution of a court ordered case plan?
  • The answers to these and other questions that may arise will guide the decision about the need for dual case management.

    Notification
    If you determine a client needs services from both the tribe and the county, the agencies must work closely together to keep each other informed of the activities of the other. In all instances of determination of eligibility for CW-TCM services made by the county for an Indian child, the county must notify the tribe of such eligibility within seven days according to the Minnesota Tribal/State Agreement on Indian Child Welfare and the Minnesota Indian Family Preservation Act (MIFPA). When the client needs services from both agencies, the tribal social services agency and the county agency must decide jointly what case management services the client needs and who can best provide them. Then they must develop the case plan based on these decisions and detail which agency will provide which services.

    Coordination of Services for a Tribal Member
    Designate a primary case manager when the client needs case management services from both the county and the tribe. When the county, tribe and family designate a primary case manager by mutual consent, clearly outline this person’s role and responsibilities in this capacity in the written case plan. If the county, tribe and family cannot reach agreement about a primary case manager, the tribal agency is responsible for making this decision with the best interests of the child in mind. Record this in the case plan. Document in detail the roles of each case manager. It must be clear that each case manager has a distinct role with the family, and the written case plan must indicate how and with what frequency case managers will communicate.

    If a county and a tribal social services agency are unable to coordinate, but are providing appropriate services to the same child, both agencies must document the activity accurately and completely. If they duplicate services, they will be at risk of disallowance, that is, one of the duplicated claims may be taken back in the case of a state or federal audit.

    Nonduplication of CW-TCM Services by a County Agency and Its Contracted Vendor

    Examples of considerations to determine when dual case management is necessary and appropriate for a client include the following:

  • • What are the needs of the client and his or her family? Will you need to refer the client or family to the county for services such as family preservation services, CD services, etc.?
  • • Will a single case manager from the contracted agency meet the client’s needs, or will the client also need the services of a county case manager (not county services, but actual case management)?
  • • Does a court order exist that requires the county to be responsible for the execution of a court ordered case plan?
  • • What role will the vendor fulfill that the county case manager cannot fill or vice versa?
  • • Does the child qualify for both child welfare targeted case management and mental health targeted case management services and are two case managers necessary to meet the child’s needs?
  • The answers to these and other questions that may arise will guide the decision about the need for dual case management.

    Coordination of Services for County and Vendor
    Designate a primary case manager when the client needs case management from both the county and the vendor. When the county, agency and family designate a primary case manager by mutual consent, clearly outline this person’s role and responsibilities in this capacity in the written case plan. Document in detail the roles of each case manager. It must be clear that each case manager has a distinct role with the family, and the written case plan must indicate how and with what frequency case managers will communicate.

    If duplication of services occurs, both providers will be at risk of disallowance, that is, one of the duplicated claims may be taken back in the case of a state or federal audit.

    Documentation of CW-TCM Services When Dual Case Management is Needed

    Documentation has two components – case plan and service delivery. Documentation in the case plan must be clear and detailed regarding a client’s need for more than one case manager.

    Case Plan–Dual Case Management

    The jointly developed case plan must describe the circumstances that necessitate dual case management services, and the specific non-duplicative roles each case manager will fulfill in accomplishing the goals of the case plan, including who will act as the primary case manager. The case plan should contain information about who will coordinate, assure access, and monitor each type of service needed by the client. It should also state the frequency with which contact between case managers will occur for the purpose of coordinating services. Each agency must retain a copy of the case plan in the case record.

    Case Record

    The case record must contain a written description of each encounter of CW-TCM services provided to each individual client. This description must include the following:

  • • Client name
  • • Case number
  • • Date of birth
  • • Date of service
  • • Name and relationship of the contacted person to the client (unless the relationship information is included elsewhere in the file)
  • • Nature and extent of service being provided
  • • Name and professional title of the person providing the services
  • • Type of contact (face-to-face or telephone)
  • • Location of contact
  • The case record should contain a description of all case management activities on behalf of the client whether or not a billable contact occurs.

    Noncovered Services

    The following services are not covered:

  • • Assessments prior to opening of case (this is the assessment to determine if the child meets one of the criteria for eligibility to receive CW-TCM services)
  • • Therapy and treatment services
  • • Legal services, including legal advocacy, for the recipient
  • • Information and referral services provided to clients who are not part of the target group or eligible for MA or MinnesotaCare
  • • Outreach services, including those provided through the community support services program
  • • Services that are not documented as required under Minnesota Rules, parts 9505.2165 and 9505.2175
  • • Services that are otherwise eligible for payment on a separate schedule under rules of the Department
  • • Case management services that duplicate the same services from another case manager (including a vendor, tribe or other case management program) for the same recipient
  • • Case management services provided to patients or residents in an MA reimbursed facility (except as defined in CW-TCM activities)
  • • CW-TCM services for children in non-MA reimbursable foster care, group homes or residential care that do not focus on permanency planning or return to the family home or that duplicate a facility's discharge planning (Minnesota Statutes 256B.094, subd.8 (10))
  • • CW-TCM services for children in an Institutions for Mental Disease (IMD) (usually for CD treatment) or a state-operated corrections facility or the secure unit of any residential facility unless it is for discharge planning as stated under the covered services section
  • • Transportation of a client
  • Authorization Requirements

    The recipient must meet the eligibility criteria to receive services from a county or tribal social service agency or contracted vendor.

    Billing

    Refer to the following billing criteria:

  • • Bill on the 837P in MN–ITS for dates of CW-TCM service delivery
  • • Counties and contracted vendors may submit a claim each month that a documented, reimbursable contact occurred
  • • One county and one tribal case manager and one case manager under contract with the county or tribe may each bill for a month they provided and documented services
  • • Bill MHCP regardless of the recipient’s enrollment in a pre-paid health plan (PMAP)
  • • Do not bill for services reimbursed under another funding source, such as the Indian Child Welfare Time Study or Local Collaborative Time Study (LCTS)
  • • MHCP will retain a portion of the federal share of the reimbursement for administrative services
  • • Counties and contracted vendors may bill one unit per month per recipient
  • • MHCP pays the contracted vendors the rate negotiated with the county or tribal agency; the county of financial responsibility or the tribe is then billed for the non-federal share
  • • For county providers and contracted vendors, the appropriate HCPCS codes are:
  • • T2023 with the modifier U3 for face-to-face contact
  • • T2023 with the modifiers U3 and U4 for telephone contact
  • • Tribal agencies may submit claims on a per-encounter basis
  • • Tribal agencies may bill only one encounter per client per 24-hour period
  • • For tribal governments, the appropriate HCPCS codes are:
  • • T1017 with the modifier U3 for face-to-face contact
  • • T1017 with the modifiers U3 and U4 for telephone contact
  • Legal References

    Minnesota Statutes, section 256B.0625, subd.33
    Minnesota Statutes, section 256B.094

    Minnesota Statutes, section 256F.10
    , subd. 5
    Minnesota Statutes, section 260C.212,
    subd. 1
    Minnesota Statutes, section 626.556
    , subd. 10e
    Minnesota Statutes, section 260C.007
    , subd. 6
    Minnesota Statutes, section 256B.02
    , subdivision 7, paragraph (c)
    Minnesota Rules, part 9505.2165

    Minnesota Rules, part 9505.2175

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