Case Management Services - Adult Mental Health Targeted Case Management (AMH-TCM)

Brief definition of services

A case manager assists an individual in identifying the individual's goals, strengths and needs; plans with the individual what services and community resources might help the individual to accomplish the individual's goals; helps refer (and often accompany) the individual to obtain services and resources; and then monitors and coordinates with those services and resources to assure that the individual is getting the help needed to accomplish the individual's goal and to address the individual needs.

These are the four service components to AMH-TCM services that case managers provide to their clients:

1. Assessment
2. Planning
3. Referral and linkage
4. Monitoring and coordination.

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Individual & Case Manager Working Relationship cycle: 1) Assessment: review diagnostic assessment, complete screenings, functional assessment, & level of care,reassessment.; 2) Planning: develop Individual Community Support Plan (ICSP), & ongoing updates; 3) Referral & Linkage: Implement the ICSP, acquire resources, services, natural supports; 4) Monitoring & Coordination: Review of individual goal progress & effectiveness of services, resources & supports.  

The case manager is helping the client to access any needed service or community resource (not just mental health services). Common services and resources include: health care coverage, affordable housing, medical/dental/vision services, financial benefits, support groups, social clubs and organization, vocational training programs. Services and resources that will help the individual to accomplish the individual's goals and recovery, address needs, and support the individual's self-sufficiency and participation in community life.

Case management services are usually provided in the client's home and community and the site of services and resources that the client is being referred to. The case manager usually meets with the individual once or twice a month. With releases of information from the client, the case manager does lots of telephone coordination with service providers and community resources that the client is interested in and/or using.

Minnesota statute defines adult Mental Health Targeted Case Management services (AMH-TCM) as activities that are designed to help adults with serious and persistent mental illness in gaining access to needed medical, social, educational, vocational, and other necessary services as they relate to the client’s mental health needs. Case management services include developing a functional assessment, and individual community support plan, referring and assisting the person to obtain needed mental health and other services, ensuring coordination of services, and monitoring the delivery of services.

Adult Mental Health Targeted Case Management is not:

  • • therapy or rehabilitation services;
  • • teaching basic living skills;
  • • legal services;
  • • performing a diagnostic assessment;
  • • administration, management or monitoring of a client’s medications; or
  • • transportation services.
  • Eligibility

    An individual is generally interested in, or referred to, case management services because the adult is looking for help in coping with the mental illness, finding services and resources to support the individual in living independently and accomplishing goals.

    Typically, the adult 's mental illness has caused significant disruptive periods in the individual's life. The symptoms of the mental illness and the resulting problems with coping may have resulted in psychiatric hospitalizations, residential treatment, crisis situations. Adults receiving AMH-TCM typically have diagnosis of major depression, bipolar disorder, or schizophrenia.

    More specifically, AMH-TCM services are targeted for adults with a "serious and persistent mental illness." Serious and persistent mental illness is defined in Minnesota Statute (M.S.) 245.462 Subdivision 20.

    AMH-TCM is a service for adults age 18 and older. There is no upper age limit.

    AMH-TCM is a covered service for eligible enrollees in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance. If an individual's private health insurance does not cover AMH-TCM services or if the individual is uninsured, the individual may be able to obtain AMH-TCM services through their county human services department.

    (NOTE: There are mental health case management services for children with emotional disturbances. This is called Children's Mental Health Targeted Case Management.

    How to Assess Services

    Individuals, or their family or friends or service providers, who think that the individual might benefit from MH-TCM services can obtain more information by contacting the social/human services department of the county of residence, or tribal authority of the tribe that the individual is a member of, or the health plan that the individual is a member of.

    Eligibility for and the appropriateness of MH-TCM services will need to determined. This includes an interview with the individual.

    A diagnostic assessment will need to be completed (or if there is a current diagnostic assessment completed within 180 days, it will need to obtained and reviewed).

    In the “fee-for-service” model, the county, as the Local Mental Health Authority, determines eligibility for AMH-TCM for county residents. The tribal authority can determine eligibility for AMH-TCM for tribal members to be provided AMH-TCM by the tribal authority enrolled in the MHCP as a recognized provider or a provider agency contracted by the tribe.

    In the “fee-for-service” model, as the Local Mental Health Authority, a county is responsible for the provision of adult MH-TCM to eligible residents, including individuals without insurance coverage or insurance coverage that does not cover MH-TCM, of the county.

    In the “pre-paid managed care” model, the managed care organization (MCO) (health plan or county-based purchasing organization), or an entity designated by the MCO, determines eligibility for AMH-TM for the MCO’s members.

    In determining initial eligibility for AMH-TCM, there needs to be a current diagnostic assessment of the individual. The diagnostic assessment needs to have been completed within the previous 180 days.

    A new diagnostic assessment must be completed as least very three years as part of the determination of continuing eligibility for AMH-TCM.

    Coverage by Minnesota Health Care Programs

    AMH-TCM is a covered service for eligible enrollees in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance. If an individual's private health insurance does not cover AMH-TCM services or if the individual is uninsured, the individual may be able to obtain AMH-TCM services through their county human services department.

    Provider Agencies and Individual Case Managers

    AMH-TCM provider agencies are of 4 types in the “fee-for-services” model:

  • • County-run provider agency enrolled in the Minnesota Health Care Programs (MHCP) as a recognized provider (M.S. 245.4711);
  • • County-contracted provider agency enrolled in the MHCP as a recognized provider (M.S. 245.4711);
  • • Tribe-run provider agency enrolled in the MHCP as a recognized provider; or
  • • Tribal-contracted provider agency enrolled in the MHCP as a recognized provider
  • The private AMH-TCM provider agency must have a contract with each county whose residents (except tribal members if the agency has a contract with a tribe) that provider agency targets to serve.

    In the “pre-paid managed care” model of service delivery, the AMH-TCM provider agency must have a contract (or formal agreement) with the provide AMH-TCM services to eligible enrollees of the MCO.

    Individual Case Manager Qualifications

    To provide quality adult MH-TCM, case manager must be skilled in:

  • • building a partnership with the adult to support and motivate the adult’s plan for change and recovery;
  • • identifying and assessing a wide range of adult needs and recipient strengths and internal resources;
  • • knowledgeable about local community resources/services/supports and how to use these and the adult’s natural support system for the benefit of the recipient; and
  • • building working alliances with representatives of these resources/services/supports for the benefit of the adult.
  • A case manager must meet the qualifications specified in M.S. 245.462 Subd.4.

    A case manager associate must meet the qualifications specified in M.S. 245.462 Subd.4.

    All case managers and case manager associates are required to have ongoing continuing education; whether required to maintain their license; or at least 30 required hours every two specified in M.S.245.462 Subd. 4 for non-licensed case managers.

    A case manager or case manager associate must be employed by one of the types of AMH-TCM provider agencies noted above.

    Clinical Supervision

    “Clinical supervision” means the oversight responsibility for individual treatment plans and individual mental health service delivery, including that provided by the case manager and case manager associate.

    Clinical supervision ensures the appropriateness of assessment and the mental health services planned and provided and provides case managers and case management associates with direction and guidance on provision of services to individual clients.

    A case management clinical supervisor must meet the criteria for mental health professionals, as specified in statute Reimbursement from MHCP’s requires that the professional be licensed at the independent clinical level or tribal-credentialed mental health professional, and be enrollable in the MHCP provider system as a licensed mental health professional. Mental health professional qualified under M.S. 246.462 subdivision 18, subpart (7). unlicensed mental health professionals do not qualify as clinical supervisors of AMH-TCM services reimbursed by MHCPs. Clinical supervision must be accomplished by full or part-time employment of or contracts with licensed mental health professionals.

    All case managers and case manager associates, other than licensed mental health professionals, have to have ongoing clinical supervision. M.S.245.462 Subd. 4. And Subd. 4a. provide information about clinical supervision and frequency. The clinical supervision can be done one-to-one with the case manager or CMA; and involve some clinical supervision in small groups.

    Other resources.

    More information on the services (Under construction)

    Common Questions and Answers (Under construction)

    MHCP Provider Manual – Mental Health Services (Chapter 16)

    Adult Case Management Web-Based Training Curriculum (PDF) 2 pages (mandatory for some new case managers/associates)

    Functional Assessment Web-based training curriculum
    • Go to DHS Trainlink
    • Click the Adult and Children’s Mental Health Link then Click Sign On in the upper right corner and enter your Unique Key and Click GO
    • Click Course Search/Online Learning
    • Select AMH: Functional Assessment 101 and click GO
    • Go into “For registration information, click here”
    • Click on Start Course

    Level of care assessment- MHCP Provider Manual page- LOCUS

    2010 MH-TCM survey summary (PDF) 8 pages

    Minnesota Statute 245.4711 Case Management Services

    Minnesota Statute 245.462 Case Management definitions

    Minnesota Statute 256G Unitary Residence and financial responsibility

    Minnesota Administrative Rule
    Minnesota "administrative rule" is a regulatory document adopted to implement and make specific a law administered by a state agency (Minnesota Department of Human Services - concerning AMH-TCM). The rule sets forth the nature, standards and requirements related to the administration of the specific law. Rules are written by DHS with formal public comment/input process.

    Minnesota Rules, parts 9520.0900 to 9520.0926 (often called Rule 79) establish standards and procedures for providing AMH-TCM services; and are intended to comply with, and must be read in conjunction with Minnesota Statutes cited above and the MHCP Provider Manual. The Minnesota Rules parts 9520.0900 to 9520.0926 related cot case management may be found under Chapter 9520 (Mental Health Services)

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