Revision 19-4; Effective September 9, 2019

 

A service authorization (SA) for Targeted Case Management (TCM) is created in the Service Authorization System Online (SASO) for all Medicaid recipients receiving service coordination from a local intellectual and developmental disability authority (LIDDA).

 

4100 Creating a TCM Service Authorization in SASO

Revision 19-4; Effective September 9, 2019

 

For persons enrolled in Home and Community-based Services (HCS) or Texas Home Living (TxHmL), or Medicaid recipients receiving service coordination from a local intellectual and developmental disability authority (LIDDA), the first billing for a Target Case Management (TCM) event results in a service authorization, which is effective for one year after the first TCM event.

The service authorization (SA) is identified in SASO as Service Group (SG) 14 or “SG 14 SA,” which is associated with TCM provided by a LIDDA.

 

4200 Requesting an Existing TCM Service Authorization be Closed

Revision 19-4; Effective September 9, 2019

 

If a person with SG 14 service authorization (SA) enrolls in another Texas Health and Human Services Commission (HHSC) program in which receiving Target Case Management (TCM) is mutually exclusive with receiving services through the other program, such as Community Living Assistance and Support Services (CLASS), the person’s existing TCM SA must be closed. If the SG 14 SA is open, the SA for the other program cannot be entered in the Service Authorization System Online (SASO) because the two are mutually exclusive. Furthermore, the local intellectual and developmental disability authority (LIDDA) has no ability to manually close the TCM SA.

 

4210 HHSC Staff Requests

Revision 19-4; Effective September 9, 2019

 

If Texas Health and Human Services Commission (HHSC) is notified that a person who has an open service authorization (SA) for Targeted Case Management (TCM) will be enrolling in another HHSC program that is mutually exclusive with TCM, the appropriate regional HHSC Regional Claims Management Services (CMS) coordinator is contacted to resolve the mutually exclusive SA issue. The regional CMS coordinator contacts the designated HHSC staff in the Local Procedure Development and Support Unit. The designated staff:

  • follows up with the appropriate local intellectual and developmental disability authority (LIDDA) to ensure the LIDDA staff are aware of the person’s change in program and to confirm that TCM will not be provided after the person’s enrollment date for the other HHSC program; and
  • notifies the regional CMS coordinator that the LIDDA is aware that the person’s TCM service authorization will be or has been closed.  

The regional CMS coordinator enters an end date for the SG 14 SA in Service Authorization System Online (SASO).

 

4220 LIDDA Requests

Revision 19-4; Effective September 9, 2019

 

If the local intellectual and developmental disability authority (LIDDA) is notified that a person with an SG 14 service authorization (SA) will be enrolled in a Texas Health and Human Services Commission (HHSC) program that is mutually exclusive to Targeted Case Management (TCM), the LIDDA:

  • identifies the regional Claims Management Services (CMS) coordinator for the LIDDA’s area;
  • informs the regional CMS coordinator that the person is enrolling in an HHSC program that is mutually exclusive to TCM;
  • requests that the regional CMS coordinator close the person’s service authorization for TCM; and
  • does not provide TCM to the person after their enrollment in the HHSC program that is mutually exclusive to TCM.

The regional CMS coordinator enters an end date for the SG 14 SA in SASO.

 

4300 List of Regional CMS Coordinators

Revision 19-4; Effective September 9, 2019

 

Texas Health and Human Services Commission (HHSC) regional Claims Management Services (CMS) coordinators are assigned to specific regions in the state. The list of coordinators by region and their contact information is found here.

 

4400 Billing Resolutions Request

Revision 19-4; Effective September 9, 2019

 

Form 1595, Billing Resolutions Request, is available for a local intellectual and developmental disability authority (LIDDA) to communicate billing issues to the regional Claims Management Services (CMS) coordinator.