The Centers for Medicare and Medicaid (CMS) recently issued new regulations for Targeted Case Management, which is a Medicaid program.

What is Targeted Case Management?

Targeted Case Management (TCM) is a Medicaid funded program that helps states to pay for services to unique groups of individuals who have higher than normal costs for case management. It helps pay for
services to obtain and coordinate medical, social, educational and other services for people with disabilities.

As part of the 2005 Deficit Reduction Act, Congress defined the term “targeted case management.” Congress did this to prevent fraud and abuse. Some states had received extra money for services and other programs that they should not have received.

What is the new definition of Targeted Case Management?

The new regulations that will take affect on March 3, define TCM as case management that helps Medicaid beneficiaries get medical, social, education, and other services that are needed.

Why should I care?

In the past TCM has been used to help with transportation and other services that people with spinal cord injuries and disorders and who are on Medicaid may use. Now transportation will not be covered, and it may be more difficult to get needed services under Medicaid if a state chooses not to provide them.

Also, a big change is if someone is in an institution and wants to move out and return to the community, Medicaid will only pay for 60 days instead of 180 days of case management. This is too short a time to find appropriate housing, community supports and other services for people with complex needs. The result will be more people in institutions and fewer in their own communities.

What can I do?

There are currently two bills in Congress, S. 2578 and H.R. 5173 that would delay implementation of the new rules until April 2009. This would give Congress time to look at and change the new regulations. It is a good opportunity to contact your Representatives and Senators in Congress and let them know that this new regulation will hurt people with spinal cord injuries and disease.

• Your Senators and Representative all have local offices. You can find them in the blue pages of the phone book under US Government – House of Representatives or Senate.
• To send an email to your Senators, go to www.senate.gov. and click on your state to find your Senators’ names or click on their names from the alphabetical list. Once you get to each Senator’s home page, you will see a way to send an email or click on “Contact.”
• To send an email to your Representative, go to www.house.gov and click on Write Your Representative (left top of House home page). Once you get to each Representative’s home page, you will see a way to send an email or click on “Contact.”