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Shasta County Health and Human Services Agency
Quality Management Tip Sheet
Targeted Case Management (TCM)
Targeted Case Management (TCM) is a service that assists a beneficiary in accessing
needed medical, educational, social, prevocational, vocational, rehabilitative, or other
community services.
Targeted Case Management and Case Management are just different terms for
the same SMHS.
The service activities may include but are not limited to,
• Communication, coordination and referral;
• Monitoring service delivery to ensure beneficiary access to services and the
service delivery system;
• Monitoring of the beneficiary’s progress;
• Placement services; and
• Plan development.
TCM services may be face-to-face or by telephone with the client or significant
support persons and may be provided anywhere in the community.
Services may be provided by any person determined by Shasta County to be
qualified to provide the service, consistent with the scope of practice and state law.
TCM services require a comprehensive assessment and annual reassessment of
TCM needs to establish the necessity and continued necessity for TCM services.
Assessments may be done more often as appropriate.
• The TCM assessment includes, but is not limited to, assessing the client’s
support network availability, adequacy of living arrangements, financial
status, employment status, and potential training needs.
TCM services require the development and periodic revision of a care plan based
on information collected through the assessment.
• The TCM Care Plan must be monitored and updated on an annual basis or
more often as appropriate.
See Targeted Case Management Care Plan Progress Note Tip Sheet for more
information on the TCM Care Plan requirements.
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Linkage is the act of connecting a client to a service or resource that supports them
achieving their treatment goals.
Brokerage is acting as an intermediary between a client and services/resources.
Sample Targeted Case Management Activities
Monitoring client progress towards goals: For example, you ask the support person
to report on the symptoms and behaviors he/she has observed from the client and to
report on his/her perspective on client’s progress towards his/her goals in order to
monitor the client’s current functioning and progress.
Referring/linking client or support person to a community resource: You refer the
support person, client, or both to a resource within the community that will assist with the
client increasing their functioning within the community or decreasing mental health
symptoms and behaviors. Common linkage examples: housing, pharmacy, drug and
alcohol treatment/support groups, college, employment or vocational resources (i.e.:
Department of rehab), financial resources (i.e. payee).
Monitoring Service Delivery: You contact a resource provider to monitor the client’s
access to the service.
Example: This writer called Steve Holden to verify that the Opportunity Center is
continuing to attempt to place client on a Janitorial Crew. Steve reported that client is on
a waiting list and that an opening is expected in approximately one month. Steve stated
that the client has been informed and that they will call the client as soon as the opening
is available.
Linking: When writing a case management note, be aware that “linkage” is a case
management activity, which can be specified in your introduction, whereas the
interventions section of your note needs to reflect the mental health interventions you
use to support the client’s functioning and progress toward his goals (this is if the service
directly involves the client or support person).
The intervention area of your note should make it clear why linking the client to a
community resource is a Medi-Cal reimbursable activity as opposed to just
transporting a client to get their medication or to an appointment, etc. It’s fine to
write in your Interventions that you linked a client to a community resource, but you must
also include how it supported the client reaching their goals, what you did (besides
driving them) that supported them in accessing the resource.
Examples of interventions you might use when linking:
When using the following terminology, be sure to expand using behaviorally specific
language as shown below.
Active listening (Writer used active listening to build rapport and strengthen
relationship in order to better support the client’s functioning and achieving her goal
of…)
Redirected (Writer successfully redirected client by…writer attempted to redirect
client by…)
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Listened empathically/validated client’s feelings (This writer listened
empathically and validated client’s feelings when he talked about…)
Open-ended questions (This writer used open-ended questions to monitor client’s
current functioning and progress. Client reported…)
Modeled (This writer modeled assertive, non-violent communication… This writer
modeled positive social interaction in the community by…)
Prompted (Writer prompted client to use coping skills of… in order to better tolerate
her frustration, anxiety, anger, etc.)
Psychoeducated/Educated(This writer psychoeducated/educated client about how
physical activity can have a positive effect on relieving symptoms of depression and
explored with client his experience with physical activity.)
Consulting with another Shasta County Mental Health employee: Consultation is
sometimes necessary when working in teams, collaborating with colleagues on
treatment interventions, and in instances where a client may be transferring from one
staff to another or one staff is filling in for another, etc. This can include team meetings,
such as clinical care, to discuss progress and treatment interventions for a specific
client. In this case, you would bill only for the time that you were actively participating in
the consultation for the client. When documenting, you need to specify why/how you
contributed, why was your participation important, necessary, what information
was exchanged, planned interventions, etc.
Title 9, Article 2, 1840.314. When services are being provided to or on
behalf of a beneficiary by two or more persons at one point in time, each
person’s involvement shall be documented in the context of the mental
health needs of the beneficiary.
Example: This writer met with clinical care team to discuss client’s current functioning,
progress and identified needs. Clinical Program Coordinator, staff nurse, Board and
Care Manager, and this writer were present for team meeting. This writer has met with
client 4 times in the past 2 weeks and gave update on observations of client’s
functioning and progress. Client has recently had an increase in altercations with
housemates and has not been open to using communication skills and skills for coping
with his frustration. Board and Care manager told this writer that client was doing better
and only recently began having more trouble managing his behaviors. Team discussed
possible interventions to support client managing his anger and frustration. Suggestions
included working with client in the moment, role playing, helping client to explore
possible consequences of not managing his emotions.
Plan: This writer will work with client on positive and constructive communication and
anger management.
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IMPORTANT BILLING CHANGE – Chart Review is no longer billed
separately as TCM (per new guidance from DHCS)
Chart Review:
Chart review is a billable service, however, it can only be billed when it is included
with a billable service, whether the chart review happens before or after the service.
The time for chart review should be included in the billable service, regardless of the
service code, (e.g., TCM, individual therapy, rehab, etc.) and regardless of whether
you did the chart review on the same day as the service.
For example: you know you’re going to meet with a client first thing the next morning
and won’t have time to review the chart in the morning before meeting with the client.
You perform your chart review the afternoon before the appt. You would track the
time you spent reviewing the chart and include that time in your service time for the
appt the next day.
Billing for Chart Review when a client doesn’t show up
You may bill for reviewing a chart when a client does not show up for their
appointment, however, the time must be included with a billable service.
For example, you review the client’s chart in preparation for providing a service to
the client and they do not show up for their appointment, you may claim the time
spent reviewing the chart as part of your service time the next time you provide a
billable service.
