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 approved by the Centers for Medicare and Medicaid Services (CMS). The SPA includes the following changes: a) Adding Autism Spectrum Disorder (ASD) as a covered diagnosis, b) Removing the needs-based criteria, c) Revising the qualifications and training requirements for Targeted Case Managers, and d) Revising 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 read the approved SPA pages.
May 10, 2019
