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TCM Provider Monthly Report

Targeted Case Manager Report

Due by the 10th of each month. Please complete and submit the form below each month by the 10th.

Report definitions.

Email address if you want to receive a copy of this report submission.

II. Targeted Case Management

VII. Targeted Case Management Contacts: Ongoing

Face-to-Face Visits
Telephonic Contact

VIII. TARGETED CASE MANAGEMENT CONTACTS: ANNUAL MCO Person Centered Service Plan (PCSP)

Members Due
PCSP Complete and Signed with TCM Present

Report Definitions

Term Definition
II. TARGETED CASE MANAGEMENT  
A.  Number of Targeted Case Managers Total number of Targeted Case Managers working at your agency
B. Percent of Targeted Case Managers who meet minimum qualifications Total percent of Targeted Case Managers working at your agency who meet all the minimum qualifications
C. Average case load size across all Targeted Case Managers Average caseload size of your agency’s TCM team
1. Maximum Caseload The number of cases on your highest caseload on your agency’s TCM team
2. Minimum Caseload The number of cases on your lowest caseload on your agency’s TCM team
D. Number of members receiving Targeted Case Management services  
1. HCBS IDD How many IDD members does your entire TCM team serve?
2. HCBS SED How many SED members does your entire TCM team serve?
3. HCBS TA How many TA members does your entire TCM team serve?
4. HCBS AU How many AU members does your entire TCM team serve?
5. HCBS IDD Waiting List How many IDD waitlist members does your entire TCM team serve?
6. HCBS AU Proposed Recipient List How many AU proposed recipient list members does your entire TCM team serve?
VII. TARGETED CASE MANAGEMENT CONTACTS: ON-GOING  
A. Total members in HCBS with an assigned Targeted Case Manager How many members your TCM agency provides TCM services, and are assigned a TCM, for the particular waiver listed for the MCO you are submitting the document to for the month indicated.
1. HCBS IDD  
2. HCBS SED  
3. HCBS TA  
4. HCBS AU  
5. HCBS IDD Waiting List  
6. HCBS AU Proposed Recipient List  
B. Total UNDUPLICATED members with face-to-face visit with Targeted Case Manager Face-to-face visit means either in person visit with member and their team or virtual meeting meeting with member and their team. The member must be able to have visibility of TCM face for meeting to be considered face to face. How many members your TCM agency saw face-to-face in the month indicated for the particular waiver listed for the MCO the document is being submitted to.
1. HCBS IDD  
2. HCBS SED  
3. HCBS TA  
4. HCBS AU  
5. HCBS IDD Waiting List  
6. HCBS AU Proposed Recipient List  
C. Total UNDUPLICATED members with telephonic contact with Targeted Case Manager How many members served on each waiver received at least one phone call during the reporting month. Only document 1 call per member per month. The purpose is to show contact was made, not how many times contact was made for the month.
1. HCBS IDD  
2. HCBS SED  
3. HCBS AU  
4. HCBS TA  
5. HCBS IDD Waiting List  
6. HCBS AU Proposed Recipient List  
VIII. TARGETED CASE MANAGEMENT CONTACTS: ANNUAL PCSP  
A. Total members due for an annual MCO Person Centered Service Plan (PCSP) where the TCM will be present For the MCO you are reporting to, the number of participants for whom you provide TCM, and who have a MCO Person Centered Service Plan scheduled during the reporting month and the TCM plans to be present at the PCSP meeting.
1. HCBS IDD  
2. HCBS SED  
3. HCBS TA  
4. HCBS AU  
5. HCBS IDD Waiting List  
6. HCBS AU Proposed Recipient List  
B. Total members with an annual MCO Person Centered Service Plan (PCSP) completed and signed where the TCM was present For the MCO you are reporting to, the number of participants for whom you provide TCM, who had a MCO Person Centered Service Plan meeting during the reporting month, and the TCM was present and signed the completed PCSP.
1. HCBS IDD  
2. HCBS SED  
3. HCBS TA  
4. HCBS AU  
5. HCBS IDD Waiting List  
6. HCBS AU Proposed Recipient List