DHS Targeted Case Management

What is Targeted Case Management

Medicaid Targeted Case Management is a service that manages multiple resources for Medicaid members. It is designed to help persons with intellectual disabilities, chronic mental illness, brain injury, serious emotional disorders, or developmental disabilities gain access to appropriate and necessary medical services and interrelated social and educational services.

Role of Targeted Case Managers

Targeted Case Managers facilitate the community-based assessment and planning process by working with consumers, families, service providers, and other agencies and individuals to create an individualized plan based on a comprehensive assessment of needs for each person. In addition, case managers assist consumers and/or parents or guardians in navigating the service system.

Typical responsibilities of targeted case managers include:

  • Assessing needs and completing a comprehensive assessment,
  • Developing an individualized care plan, including a crisis plan,
  • Referral for services,
  • Coordination of services
  • Ongoing monitoring to assess the consumer's safety, well-being, and stability, as well as monitoring the progress toward the goals identified in their individual care plan.

Who Provides Targeted Case Management

Iowa limits the providers of Targeted Case Management Services for individuals with disabilities to the county or the Department of Human Services.  County Boards of Supervisors are required to select the TCM provider per Iowa Code Section 225C.20.  However, the Iowa Code allows a county to subcontract for the provision of case management services.

Targeted Case Management Staff and Provider Requirements

There are over 465 Medicaid targeted case managers for persons with intellectual disabilities.  Most serve persons with chronic mental illness and developmental disabilities, which includes persons with intellectual disabilities. DHS-TCM employs 135 case managers. The additional 330 case managers are employed by the case management entities selected by the counties. 

TCM providers must meet the standards established under 441-24 of the Iowa Administrative Code.  Providers are accredited by the Division of MHDS and receive accreditation for up to 3 years. These standards set forth expectations for staff qualifications, staff development, case planning and service delivery, and documentation. 
 
Targeted case manager requirements:

  • A bachelor's degree with 30 semester hours or equivalent quarter hours in a human services field (including, but not limited to, psychology, social work, mental health counseling, marriage and family therapy, nursing, education, occupational therapy, and recreational therapy) and at least one year of experience in the delivery of services to the population groups that the person is hired as a case manager or case management supervisor to serve; or
  • An Iowa license to practice as a registered nurse and at least three years of experience in the delivery of services to the population group the person is hired as a case manager or case management supervisor to serve. 

To become and to remain a Medicaid enrolled TCM provider, the entity must be accredited under Chapter 24. In addition, TCM providers must comply with the provisions of IAC 441-90 which operationalizes the provisions in the state's Medicaid Plan that is approved by the Center for Medicare and Medicaid (CMS).

Populations Served

Populations eligible for TCM Services are:

  • Individuals with Intellectual Disabilities
  • Adults with Developmental Disabilities
  • Individuals with Brain Injury
  • Adults with Chronic Mental Illness (Iowa Plan for Behavioral Health/Magellan)
  • Adults with Chronic Mental Illness (through Habilitation/ Medicaid Option i)
  • Children with Serious Emotional Disturbance

The following factors are considered when determining the need for case management:

  • The consumer has a need for case management to manage multiple resources pertaining to medical and interrelated social and educational services for the benefit of the consumer;
  • The consumer has functional limitations and lacks the ability to independently access and sustain involvement in necessary services; and
  • The consumer is not receiving other paid benefits under the medical assistance program or under a Medicaid managed health care plan that serves the same purpose as targeted case management.
  • Medicaid Targeted Case Management is required for all persons with Mental Retardation receiving services in the Medicaid Home and Community Based Waiver Program.

DHS Targeted Case Management Program

DHS Targeted Case Management has formal, written contracts with each county they serve. The DHS-TCM contract with counties can be for one or a combination of the populations eligible for TCM services.

DHS Targeted Case Management:

  • 32 Offices throughout Iowa
  • Approximately 220 staff
  • Served 5,584 consumers in SFY 11
  • Has a TCM service agreement in 79 counties (either formal contract or informal agreement).
  • Provides TCM services to people in all 99 counties

DHS TCM served 5,584 consumers in fiscal year 2011 broken down as follows:

Intellectual disabilities (adult): 2,674 consumers
Intellectual disabilities (children): 715 consumers
Developmental disability: 162 consumers
Brain injury (adult): 192   consumers
Brain injury (children): 131  consumers
Chronic mental Illness (Habilitation) 594  consumers
Chronic mental illness (MBC)  414  consumers
Children with SED  702 consumers

Targeted Case Management Services map

Contact Information for DHS Targeted Case Management

Please feel free to contact the following individuals with any questions or concerns regarding DHS Targeted Case Management.

Diane Diamond
Bureau Chief
ddiamon@dhs.state.ia.us
(515) 281-7163

Kathleen Jordan
East Supervisor
kjordan@dhs.state.ia.us
(319) 232-0477

Pam Alger
West Supervisor
palger@dhs.state.ia.us
(515) 281-7163