March 1998 Letter re: Ongoing Service Coordination
Medicaid 97-05
March 1998
To: District Superintendents
Presidents of Boards of Education
Superintendents of Public Schools
School District Business Officials
Directors of Special Education
Chairpersons of Committees on Special Education
Superintendents of 4201 Schools
Directors of Regional Information Centers and Regional Computer Centers
From: Robert J. Scalise, Coordinator of the Finance Unit
Subject: Targeted Case Management
New York State Department of Health (DOH) staff working to develop fees for Targeted Case Management (TCM) as part of the School Supportive Health Services Program (SSHSP), have encountered problems regarding ongoing service coordination.
SCHOOL DISTRICTS CURRENTLY COLLECTING DATA FOR ONGOING SERVICE COORDINATION SHOULD CAREFULLY READ THIS LETTER.
Ongoing service coordination are those activities that assist students in gaining access to needed medical, social, educational and other services. Of the thirty-one districts involved in the TCM sample, only seven were actually documenting ongoing service coordination. In reviewing the documentation provided by these districts, over 50% of the case notes were inadequate to support ongoing service coordination. The following problems were identified.
- Case notes did not reflect sufficient effort by the service coordinator.
- Case notes did not reflect sufficient coordination by the service coordinator.
- Case notes were written solely for creating a contact, without an explanation for the contact, or indication of any action or follow-up. An example is a telephone call to a teacher inquiring about the child’s progress; no reason is stated for the telephone call, nor is any action or follow-up evident.
- Most case notes reveal that school districts are focusing their attention on the unit of service of two contacts per month, instead of the nature of the service.
After reviewing this initial documentation, DOH staff calculated
a monthly fee, which was much lower than anticipated.
Although development of an ongoing service coordination fee will
proceed, the initial guidelines will be refined and amplified. The objective
is to have school districts document the work that they do in a way that
is acceptable and therefore billable. Medicaid will not reimburse school
districts for purposeless contacts documented by cursory case notes. Medicaid
requires documentation of provided services; therefore, service coordinators’
case notes must include the following:
- the reason for a coordination contact,
- a summary of the contact and the person contacted,
- any action, reaction, service, or decision by the coordinator.
DOH anticipates posting an interim fee. This fee must first be approved by the state Division of the Budget. DOH will review initial claims submitted by school districts for ongoing service coordination prior to payment. School districts meeting the above case note criteria may bill for service coordination. School districts not meeting the case note requirements may not bill. Any school districts intending to bill should contact Mr. Michael Albino at (518) 473-9059 to set up a review of their documentation. School districts submitting inadequate documentation will not be reimbursed.
Attached are examples of case notes that adequately document ongoing service coordination contacts.
The other TCM fees for administering the Committee on Special Education process (Initials, Annuals, Triennials and Amended/Requested IEPs) will be published as soon as the Division of Budget approves them.
Should you have any questions regarding this memorandum you may contact me at 518:473-6118 or at my e-mail address: RSCALISE@MAIL.NYSED.GOV.
Specific questions regarding Targeted Case Management Services should be directed to one of the following Department of Health staff:
Laura Artale - 518: 486-7172 Dennis Dame - 518:
473-0600
Kevin Ryan - 518: 473-6790 Joseph D' Agostino -
518:474-1227
Jeff Foley - 518: 486-3429
Attachment
Lawrence L. Gloeckler
Ron Calhoun
Lou Demeo
Medicaid Coordinators, RIC