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SPA 19-0001 Targeted Case Management submitted to CMS

State Plan Amendment (SPA) 19-0001 Targeted Case Management (TCM) for Beneficiaries With Intellectual and/or Developmental Disabilities (IDD) in Community-Based Settings, with a proposed effective date of January 1, 2019, has been submitted to allow the Division of Medicaid to:

  1. Add Autism Spectrum Disorder (ASD) as a covered diagnosis,
  2. Remove the needs-based criteria,
  3. Revise the qualifications and training requirements for Targeted Case Managers, and
  4. Revise the reimbursement for TCM for beneficiaries with IDD in community-based settings from $14.88 per fifteen (15) minute unit to a rate of $151.01 per month.

For more information see the SPA draft pages.