Reimbursement |
MH-TCM Reimbursement Units/Models
MH-TCM Provider Type |
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“County provided” MH-TCM provider |
“County contracted” MH-TCM provider |
“MCO provided” MH-TCM provider |
“MCO contracted” MH-TCM provider |
“Tribal Authority provided” MH-TCM provider |
Usual provider type |
County staff |
Private agency contracted with a county |
MCO |
County/Tribal Authority/and/or Private Agency contracted with MCO |
Tribal Authority |
Reimbursement unit |
Monthly |
.Monthly |
MCO-determined (MCO paid a PMPM capitation for covered health benefits) |
Monthly – MCO can establish the requirements for provider reimbursement |
Per encounter (face-to-face; daily limit) contact with client |
How rate |
Annual TCM time study – monthly rate is unique to county or groups of counties (base on percentage of county social services cost pool)– |
Negotiated monthly rate between county and private TCM provider agency– DHS approves rate |
DHS pays the MCO a per-member-per-month capitation for all covered health benefits for MCO enrollees |
Negotiated monthly rate between MCO and MH-TCM provider – private providers can not charge MCOs less than the MA rate |
Federally determined rate |
TCM service area of provider |
Within the county; or other counties that a county has a contract with |
Within the county that private agency has contract with; private agency must have contract with each county to provide TCM within the county |
Within DHS/MCO contracted area |
Per contract between the MCO and MH-TCM provider (within DHS/MCO contract area |
To Tribal members residing within or close to reservation lands. |
Funding source |
Medicaid/State/ and/or County |
Medicaid/State/ and/or County |
Medicaid and/or |
Medicaid and/or State |
Federal/Medicaid |
Code |
T2023 |
T2023 |
T2023 |
T2023 |
T1017 |
Modifier & Service name |
HE – Face-to-face contact |
HE – Face-to-face contact |
HE –as determined by MCO |
HE –as determined by MCO |
HE – Face-to-face encounter |
Modifier & Service name |
HE U4 – Telephone contact w/ client |
HE U4 – Telephone contact w/ client |
As determined by MCO |
As determined by MCO |
NA |
Eligible provider |
County entity, Case manger; Case manager associate |
County-contracted entity, Case manger; Case manager associate |
MCO entity, Case manager; Case manager associate |
MCO-contracted County/Tribal Authority/and/or Private entity, Case manger; Case manager associate |
Indian Health Service – 638 case manager; Case manager associate |
LINK |
MH-TCM mental health codes, rates, eligible providers, and provider qualifications link: |
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