Alert #08-6


New York State Office of the Medicaid Inspector General (NYS OMIG)

School/Preschool Supportive Health Services Program (SSHSP/PSHSP)

Medicaid in Education Unit

Issue #8-6

TO:                      All SSHSP/PSHSP Medicaid Providers


FROM:                NYS OMIG SSHSP/PSHSP Medicaid in Education Unit


DATE:                September 3, 2008


SUBJECT:          Targeted Case Management (TCM) Claims



The ability for school districts to claim for Targeted Case Management Services has been extended by Congress in the form of a Moratorium to CMS Rule 2237.  School Districts can now claim for TCM services provided on or after March 1, 2008.  This moratorium is in place for TCM services provided from March 1, 2008 through March 31, 2009.


The effected rate codes are 5491 (Initial Review), 5492 (Annual Review), 5493 (Triennial Review), 5494 (Amended/Requested Review) and 5495 (Ongoing Service Coordination).


TCM claims with a service date of March 1, 2008 or later will now be accepted by Central New York Regional Information Center (CNYRIC).  CNYRIC will accept these claims and send them on to the State for processing.


The restriction on TCM claims will be re-instituted for TCM claims with a Date of Service (DOS) of April 1, 2009 and later.  The two-year window for claiming TCM services will remain in effect.


For any questions/comments regarding this alert, please contact your Regional Information Center representative, NYS Education Department Medicaid Coordinators, or NYS OMIG Medicaid in Education Unit staff.

Last Updated: March 13, 2009