Correction Regarding The Medicaid Targeted Case Management Providers Notice Posted June 26, 2014


The notice that was posted regarding Medicaid Targeted Case Management (MTCM) providers on June 26, 2014, pertaining to Medicaid Targeted Case Management was intended only for  newly enrolled private providers of MTCM. The intent was to advise newly enrolled private providers of MTCM of potential policy changes reflecting “conflict free” care management. Below is the updated correspondence distributed to newly enrolled private providers of MTCM. We apologize for any inconvenience. 

According to the Centers for Medicare and Medicaid Services (CMS), case management services must be "conflict free." This requirement has the following characteristics: a separation of care management from direct services; a separation of eligibility determination from direct services; case managers do not establish the levels of funding for individuals; and anyone who is conducting evaluations, assessments and the plan of care cannot be related by blood or marriage to the individual or any of his or her paid caregivers.

The South Carolina Department of Health and Human Services (SCDHHS), with the input of the provider and advocate communities, is developing new policies to ensure compliance with CMS mandated "conflict free" case management. SCDHHS will notify the provider community of new policies. Until such time, providers will act under the current policy. However, providers should note significant changes may come as a result of the Home and Community Based Services (HCBS) Final Rule.

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