The Social Security Act (SSA) regulates and funds Medicaid for the poor and disabled. In Minnesota, Medicaid is known as Medical Assistance or M.A.
Federal regulations are issued by the federal Centers for Medicare and Medicaid Services (CMS). The State Operations Manual is published by CMS to provide guidance to states. The Office of the Inspector General conducts audits to ensure states are following federal Medicaid regulations.
In 1981, Congress amended the Social Security Act to include case management services. In 1985, it was amended again to give states an option to cover case management services targeted at specific groups, such as persons with developmental disabilities or mental illness.
Each state has its own plan, approved by CMS, that describes which services are covered.
Mental health services for children with a severe emotional disturbance (SED), adults with a serious mental illness (SMI) and adults with a serious and persistent mental illness (SPMI) are funded in large part through the federal Medicaid program.
While CMS requires states to cover a core set of physical and behavioral health services, each state may elect to cover additional services or optional services.
In Minnesota, Mental Health - Targeted Case Management for adults with SPMI and children with SED are optional services. Minnesota worked with CMS to define specific services and requirements for MH-TCM.
Federal regulations (SSA) and Minnesota state statutes, rules and policies govern the delivery and documentation of adult MH-TCM services. In the event of a conflict between state and federal regulations, the federal regulations take precedence.