Chapter 106 Targeted Case Management - Alabama Medicaid Agency

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Targeted Case ManagementRecipients with related conditions are individuals who have a severe chronicdisability described by all of the following criteria:• Attributable to Cerebral palsy or epilepsy; or any other condition, otherthan mental illness, found to be closely related to mental retardationbecause this condition results in impairment of general intellectualfunctioning or adaptive behavior similar to that of mentally retardedpersons, and requires treatment or services similar to those required forthese persons• Likely to continue indefinitely• Results in substantial functional limitations in three or more of thefollowing areas of major life activity:−−−−−Self-careUnderstanding and use of languageLearningMobilitySelf-direction or capacity for independent livingSeriously Emotionally DisturbedA recipient is considered seriously emotionally disturbed if they meet at leastone criterion from column 1, Mental Health Treatment History, or 2, Indicatorsor Mental Health Treatment Needs, and two criteria from column 3, CurrentFunctioning Problem Areas.Mental Health TreatmentHistoryHas undergone mentalhealth treatment moreintensive than outpatientcare (emergency servicesor inpatient services)Has experiencedstructured, supportiveresidential treatment, otherthan hospitalization, for atotal of at least two monthsin their lifetimeHas been assigned to aprogram of psychotropicmedicationHas received mental healthoutpatient care for a periodof at least six months, or formore than 20 sessions, orhas been admitted fortreatment on two or moreoccasionsIndicators of Mental HealthTreatment NeedsFamily history of alcohol or drugabuseFamily history of mental healthtreatmentFailure to thrive in infancy orearly development indicated inmedical recordsVictim of child abuse, neglect,or sexual abusePervasive or extreme acts ofaggression against self, others,or property (homicidal orsuicidal gestures, fire setting,vandalism, or theft)Runaway episode(s) of at least24 hours’ durationCurrent FunctioningDoes not attend school (andhas not graduated), is enrolledin a special educationcurriculum, or has poor gradesDysfunctional relationship withfamily and peersRequires help in basic, ageappropriateliving skillsExhibits inappropriate socialbehaviorExperiences seriousdiscomfort from anxiety,depression, irrational fears,and concerns (indicated byserious eating or sleepingdisorders, extreme sadness,or social isolation)106-8 January 2011
Targeted Case Management 106NOTE:Consider current functioning problem areas of one-year duration or withsubstantial risk of over one year duration.Sensory ImpairedBlind recipients have no usable vision after the best possible correction. Theymust rely on tactile and auditory senses to obtain information.Partially sighted recipients have a visual acuity of 20/70 or less in the bettereye with the best possible correction. They also have a peripheral field sorestricted that it affects their ability to learn, or a progressive loss of visionwhich may in the future affect their ability to learn.Deaf recipients have a hearing impairment that is so severe that they areimpaired in processing linguistic information through hearing, with or withoutamplification. This impairment adversely affects educational performance.Blind multihandicapped recipients have a visual impairment (either blind orpartially sighted as defined above) and a concurring handicapping condition.Deaf multihandicapped recipients have a hearing impairment (deaf as definedabove) and a concurring handicapping condition.Deaf-blind recipients have both hearing and visual impairments. Thecombination of sensory impairments causes such severe communication andother developmental and educational problems that the recipient cannot beproperly accommodated in the educational programs offered by the AlabamaSchool for the Blind or the Alabama School for the Deaf.Disabling Health Condition(s)Recipients are eligible for Targeted Case Management services if they havethe following disabling conditions, which are severe, chronic, and physical innature and require extensive medical and habilitative/rehabilitative services.• Central nervous system dysraphic states such as spina bifida,hydranencephaly, and encephalocele• Cranio-facial anomalies such as cleft lip and palate, Apert's syndrome,and Crouzon's syndrome• Pulmonary conditions such as cystic fibrosis• Neuro-muscular conditions such as cerebral palsy, arthrogryposis, andjuvenile rheumatoid arthritis• Seizure disorders such as those poorly responsive to anticonvulsanttherapy and those of mixed seizure type• Hematologic/immunologic disorders such as hemophilia, sickle celldisease, aplastic anemia, and agammaglobulinemia• Heart conditions such as aortic coarctation, and transposition of the greatvessels• Urologic conditions such as extrophy of bladder• Gastrointestinal conditions such as Hirschsprung's Disease, omphalocele,and gastroschisisJanuary 2011 106-9
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Chapter 106 Targeted Case Management - Alabama Medicaid Agency

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