February 5, 2008

Letter To DHHS Secretary Michael Leavitt Regarding Changes to Targeted Case Management

Senators Harry Reid and Max Bacus sent a letter outlining concerns about changes to targeted case management services to Department of Health and Human Services (DHHS) secretary Michael Leavitt. The letter points out that the proposed changes to Medicaid targeted case management services exceeds the scope of Congressional intent when the Deficit Reduction Act (DRA) of 2005 was passed. The senators noted that the DRA specifically says that the following targeted case management services should be considered allowable Medicaid expenses:

• Assessment of service needs

• Development of a specific care plan

• Referral to help an individual obtain needed services and monitoring

The senators said that the language in the interim final rule on targeted case management restricts services that fall in the three categories of services, which contravenes the intent of Section 6052 of the DRA. In addition, they noted that the rule prohibits bundled or capitated methodologies and requires that such services be documented in 15-minute increments. The senators said this requirement would impact states ability to seek coordinated services, but the correlation of the restriction with the DRA is not clear.