Medicaid beneficiaries who participate in Transitions to Community Living (TCL members) currently receive Tailored Care Management (TCM) services from the LME/MCOs. The Department has established a process to allow TCL members to choose to obtain TCM services from an Advanced Medical Home Plus (AMH+) practice with TCL Distinction or a Care Management Agency (CMA) with TCL Distinction, as designated by the National Committee for Quality Assurance (NCQA) and available in their geographic area.
TCL Distinction means that an AMH+ or CMA has been determined qualified to provide TCM services to TCL members based on criteria set by the Department. All TCL members will continue to receive TCL functions (e.g., pre-admission screening and diversion, in-reach, transitions, complex care) from LME/MCO TCL staff.
As of April 1, 2024, eligible TCL members who have an AMH+ or CMA provider with TCL Distinction in their geographic region may begin to select to receive TCM services from one of those AMH+ or CMA providers and can begin receiving TCM services from these providers on May 1, 2024, depending on the date of choice.
To elect to receive TCM from an AMH+ or CMA provider with TCL Distinction, TCL members must contact their LME/MCO. The Department anticipates TCM providers with TCL Distinction will be added to additional counties in the upcoming months to allow more TCL participants to select a TCL designated TCM provider.
It is important to note that Medicaid beneficiaries may not select a TCM provider (CMA or AMH+) who also provides them with Home and Community Based Services (HCBS), such as supported employment or community living and support services, due to a federal conflict-free care management requirement that the intent of conflict-free requirements is to promote member choice and independence by limiting any conscious or unconscious bias by a care manager when assisting a member in HCBS needs and developing plans to access services. A list of HCBS that are available to individuals receiving TCM includes, but is not limited to, the Innovations Waiver, TBI waiver, 1915(b)(3) and 1915(i) services.
For more information on TCM Conflict Free Guidance, see Medicaid provider bulletin article Tailored Care Management: Conflict-Free Care Management Guidance.