Library: Policy

317:30-5-1011. Coverage by category

Revised 6-25-12

         Payment is made for targeted case management service as set forth in this Section.

• (1) Adults.  Payment is made for services to persons with an intellectual disability and/or related conditions as follows:

  • (A) The target group for Developmental Disabilities Services Division Targeted Case Management (DDSDTCM) services are Medicaid eligible individuals:

    • (i) served by the Home and Community Based Waivers operated by the Department of Human Services/Developmental Disabilities Services Division (DHS/DDSD); or

    • (ii) residing in institutions who:

      • (I) have requested Home and Community Based Waiver services operated by DHS/DDSD, and

      • (II) receive targeted case management services during a transition period not to exceed 180 consecutive days immediately prior to entering the Waiver; or

    • (iii) who are being assessed for admission to the Home and Community Based Waiver operated by DHS/DDSD.

  • (B) Targeted case management services may be provided when the client, the client's family as appropriate, the client's legal representative and case manager have worked together to achieve a plan.

• (2) Children.  Services for children are the same as for adults.

• (3) Individuals eligible for Part B of Medicare.  Case Management Services provided to Medicare eligible recipients are filed directly with the fiscal agent.