Targeted Case Management Services program
Oregon Administrative Rules
Chapter 410 Division 138 - Currently on file with Oregon Secretary of State
Recent rule revisions
- 4/4/2014 (P) - Elimination of Oregon Health Plan Standard Benefit Plan Effective January 1, 2014
- 01/01/2014 (T) - 410-138-0000, 410-138-0007, 410-138-0009 - Elimination of OHP Standard benefit plan effective January 1, 2014
- 04/26/2013 (P) - 410-138-0390 – Targeted Case Management Retroactive Payments
- 10/31/2012 (T) - 410-138-0390 Targeted Case Management Retroactive Payments
Code of Federal Regulations (CFR) - Specific TCM CFRs are 42 CFR 431.50-51, 42 CFR 440.169, 42 CFR 240 and 42 CFR 441.18. Please note that the Centers for Medicare and Medicaid Services (CMS) has not updated these regulations with the partially rescinded regulations authorized by the American Recovery and Reinvestment Act in February 2009. The partial rescission of case management interim final rule was published in the Federal Register on June 30, 2009.
TCM Billing Codes and Rates - This table does not include TCM programs administered by Children Adults and Families (CAF) or Seniors and People with Disabilities (SPD) divisions.
Local match payment information
Leverage account reconciliation planned for February 2012 - DMAP mailed this letter to affected TCM, School-Based Health Services and Behavioral Rehabilitation Services providers.
Medicaid/SCHIP Local Match Leveraging Form- To receive timely payment for claims, the unit of government provider must submit a prepayment at the local match rate, so that DHS can match the prepayment to the correct claims. This form is also available in Word.
- DHS must receive the payment and completed form by Wednesday, 5 p.m. of the week you submit the claim(s). Otherwise, the claim(s) will suspend until prepayment is received.
- Make sure the form and prepayment clearly identify the match amount(s) to associate with each provider number listed on the form.
- “Remaining cash balance” (upper-left section of Leverage Claims Payable - Not Paid page) lists how much money you have left to prepay claims for the provider number listed in the “Payee ID” field.
- The Amount Total for “State Share Due” (bottom-right section of Leverage Claims Payable - Not Paid page) lists how much money you need to submit to DHS as a prepayment in order for DHS to pay the claim(s) listed.
Local match rates - The prepayment amount is a percentage of the total amount paid for claims submitted. The percentage is determined by the local match rate. Use the rates listed here, based on the claim's payment date.
Who to call for help