A patient in a state hospital for mental diseases who is under age 22 or who is age 65 or older may be eligible for Targeted Case-Management Services (TCMS) provided by a county mental health targeted case-management service provider. The provider may keep track of the patient's progress in the state institution and help the patient find and get services after he or she is discharged for up to 30 days before the expected date of discharge. The provider builds a relationship with the patient to help the patient adjust to changes during and after discharge. The provider usually helps the patient apply for MA benefits. 55 Pa. Code § 1247
The patient may apply for MA-funded TCMS only after he or she is discharged from the state institution. The CAO will decide whether the patient is eligible for MA only after he or she is discharged. The CAO must consider both retroactive and ongoing MA eligibility.
The CAO may authorize retroactive MA coverage in the correct category for an individual under age 22 (C, PC, or TC), for a disabled individual (J, PJ, or TJ), or for an individual age 65 or older (A, PA, or TA). Retroactive MA eligibility may be approved for up to 30 days before the date of discharge from the state institution if all of the following conditions are met:
The provider confirms in writing that TCMS was provided during the retroactive period and that TCMS did not duplicate or replace the institution's responsibility to provide discharge planning and continuity of care. The specific dates that TCMS was provided must be included. The patient agrees to stay involved with the provider after the discharge.
The individual meets all MA eligibility conditions for the retroactive period.
The individual meets the age conditions. The TCMS provider must give proof of the individual’s age.
If the patient is not eligible for ongoing MA benefits and is eligible only for retroactive TCMS, the CAO must take the following actions:
1. Process the Application for Benefits (PA 600) as directed in Chapter 304, Application.
2. Authorize MA as a noncontinuous eligibility (NCE) opening. Use the appropriate category (C, PC, TC, J, PJ, TJ, A, PA, or TA) for the individual’s finances and age. Enter a closing date effective the last calendar day of the period of eligibility.
3. Send a notice about the retroactive eligibility decision to the patient, and send a copy to the provider.
Updated February 14, 2012, Replacing February 8, 2002