Child Welfare Targeted Case Management (CW-TCM)

Revised: January 11, 2024

· Overview

· Eligible Providers

· Case Manager Qualifications

· Contracting with Qualified Vendors

· Eligible Members

· Covered Services

· Noncovered Services

· Billing

· Rates for Counties and Tribes

· 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, subdivision 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. Agencies must apply to DHS to become certified. 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

· 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

Federally recognized tribal governments within Minnesota may authorize individuals to serve as tribal child welfare case managers pursuant to Minnesota Statutes, 256B.02, subdivision 7, paragraph (c), and determined as meeting applicable standards (Minnesota Statutes, 256F.10, subdivision 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 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 nonfederal share of the vendor’s rate 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

Provider Type Home Page Links Review related web pages for the latest news and additions, forms, and quick links. · Alcohol and Drug Abuse · Case Management · County Human Services Agency (DHS-0005) (PDF) · Managed Care & Prepaid Health Plan · Tribal/IHS Human Services

Eligible Members

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, subdivision 1r

· At risk of maltreatment or experiencing maltreatment as defined in Minnesota Statutes, 260E.03, subdivision 12

· In need of protection or services as defined in Minnesota Statutes, 260C.007, subdivision 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 member 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 or interactive video basis are claimable as CW-TCM unless the client is in placement more than 60 miles beyond county or reservation boundaries. If a client is in placement more than 60 miles beyond county or reservation boundaries, a provider may deliver services using telephone or interactive video contact for two consecutive months. There must be a face-to-face contact in the month before the eligible telephone or ITV contacts when children have been and continue to be in placement. Examples of CW-TCM activities include, but are not limited to the following:

· Assessment of the member'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 member, the member'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 member 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 before the member'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 specific to the child. 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, and so on, 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 should exchange plans and amend their plans as appropriate.

For convenience, attach or include a family and collateral contact list with the case plan. 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, and so on. 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, subdivision 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 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 or other needed services to assist the family?

· 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 American Indian children, the county must notify the tribe of such eligibility within seven days according to 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
A tribe determines its level of involvement in providing case management to American Indian Children (county agency consults with tribes).

According to Minnesota Statutes, section 256.094, subdivision 6, a contracted vendor and the county or tribal social services agency may each receive separate payments for services provided by each entity in the same month. To prevent duplication of services, each entity must document in the member’s file, the need for team case management, and a description of the roles and services provided by each team member. Both agencies should decide jointly what CW−TCM services are needed, and which agency can best provide them. Service plans must detail which agency will provide specific services.

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 and so on?

· 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. 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

· 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.

Interactive Video (ITV)

Interactive video means the delivery of targeted case management services in real time through the use of two-way interactive audio and visual communication, or accessible video-based platforms.

CW-TCM services may be provided through ITV according to Minnesota Statutes, 256B.0625, subdivision 20b and reimbursed according to Minnesota Statutes, 256B.094, subdivision 6. ITV or face-to-face contact meets the minimum face-to-face contact requirements for CW-TCM services with the exception of children in out-of-home placement or receiving case management for child protection reasons require an eligible in-person contact.

For children and youth in foster care for whom a responsible social service agency has placement and care responsibility, the contact must be seen in- person to claim targeted case management. Foster care is defined by Minnesota Statutes, 260C.007, subdivision 18 and 260D.02, subdivision 10.

Children receiving case management for child protection reasons must be seen in person.

Exception - if the child is placed more than 60 miles beyond the county or reservation boundaries, telephone contact or ITV, is claimable for up to two consecutive months and there must be face-to-face contact at least once every three months. Providers must have a Targeted Case Management Provider Interactive Video Assurance Statement (DHS-8398) on their provider file to provide services via ITV.

Noncovered Services

The following services are not covered:

· Assessments before 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 member

· 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 member

· 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, subdivision 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 heading

· Transportation of a client

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 member’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 member

· MHCP pays contracted vendors in full. DHS then bills the county of financial responsibility or the tribe 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

· Effective July 1, 2022, county-contracted vendors that have a DHS-approved rate exception must also include the following modifiers as appropriate to the vendor’s rate exception:

· UA – low intensity (caseload size rate exception for a higher average caseload size)

· TG – high intensity (caseload size rate exception for a lower average caseload size)

· UB – culturally specific rate exception

· 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

Interactive Video (ITV)

Providers must have a Targeted Case Management Provider Interactive Video Assurance Statement (DHS-8398) on their provider file to bill claims for services provided via ITV. Services provided via ITV have the same service thresholds, reimbursement rates and authorization requirements as services delivered in-person. When services have been delivered via ITV, the appropriate place of service must be provided.

· Place of service 02: ITV contact provided other than the client’s home. The client is not located in their home when receiving CW-TCM service through ITV.

· Place of service 10: ITV contact provided in the client’s home. The client is located in their home when receiving CW-TCM service through ITV.

MHCP does not reimburse for connection charges, or origination, set-up or site fees.

Rates for Counties and Tribes

The following is rate information for counties and tribes.

Counties
The monthly county-specific CW-TCM rates are determined by multiplying the percent of staff time spent on CW-TCM activities (based on time study results from random moment sampling of social service staff participating in the Social Service Time Study), by the average monthly Social Services Cost Pool (as reported in the Social Services Fund Report), divided by the average monthly number of CW-TCM clients served (as reported in the TCM Client Statistical Report). The resulting rate represents the total monthly county cost for delivering Child Welfare-Targeted Case Management services to one child. Some counties individually do not generate the minimum number of random moment time study responses for a statistically valid sample; and therefore, must be grouped with other counties who have similar CW-TCM rates to achieve a combined federally required statistically valid number of random moment responses to use in the rate setting calculation. Counties requiring grouping will have a CW-TCM rate that is identical to other counties within their group. A county’s grouping one year may be completely different from another year as it is not locality that determines the group; rather, the like-kind rates and combined number of random moment responses to achieve a federally required, statistically valid sample. The rates for counties are adjusted annually on July 1 by the department.

Tribes
Each CW-TCM claim submitted by tribal agencies is paid at the same rate for one claim per 24-hour period. The rate is the average monthly CW-TCM rate of the counties within the Contract Health Service Delivery Area of each of the federally recognized tribes providing CW-TCM services divided by two. The rate is the same for all tribal agencies. The rates for tribal agencies are adjusted annually on July 1 by the department.

Legal References

Minnesota Statutes, section 256B.0625, subdivision 33
Minnesota Statutes, section 256B.076
Minnesota Statutes, section 256B.094
Minnesota Statutes, section 256F.10, subdivision 5
Minnesota Statutes, section 260C.212, subdivision 1
Minnesota Statutes, section 260E.03, subdivision 12
Minnesota Statutes, section 260C.007, subdivision 6
Minnesota Statutes, section 256B.02, subdivision 7, paragraph (c)
Minnesota Rules, part 9505.2165
Minnesota Rules, part 9505.2175