Under the TCM Rule 5160-48-01 “Institution” means a nursing facility, an intermediate care facility for individuals with intellectual disabilities (ICF/IID), a state-operated intermediate care facility for individuals with intellectual disabilities (ICF/IID) or a medical institution.
Activities performed on behalf of an eligible individual residing in an institution are not billable for Medicaid TCM reimbursement except for the last one hundred eighty (180) consecutive days of residence when the activities are related to moving the eligible individual from an institution to a non-institutional community setting.
Rule 5160-48-01:
Medicaid coverage of targeted case management services provided to individuals with developmental disabilities.
If you have questions about anything TCM-related, please contact us at TCMTeam@medicaidbillingsolutions.com.
