In today’s Federal Register, the Centers for Medicare and Medicaid Services (CMS) clarifies the Medicaid definition of “covered case management” and “targeted case management” (TCM) services with an interim final rule with comment period. According to the rule, case management consists of services which help beneficiaries gain access to needed medical, social, educational, and other services; “targeted” case management services are those aimed specifically at special groups of enrollees such as those with developmental disabilities or chronic mental illness.
Widespread improper billing by states of the Medicaid program for services mandated by other programs helped prompt Congress to address the problem in the Deficit Reduction Act, which redefined the scope of allowable case management services, strengthened state accountability, and required that CMS issue regulations. In one investigation of TCM claims, the Government Accountability Office (GAO) found that inappropriate billing to Medicaid generated an estimated $12 million in extra federal funds to Georgia and $68 million in extra federal funds to Massachusetts from 2000 to 2004.
The proposed clarifications are expected to save the program $1.2 billion over the next five years. Public comments will be accepted through the close of business on Feb. 4, 2008. The provisions of the interim final rule will become effective on March 3, 2008. Download the interim final rule.
