To disallow psychoeducation as a component of Targeted Case Management is concerning. In many cases, there is no one in the client's life or parent of a child's life to assist them in understanding their mental illness and the need for services to address and stabilize symptoms.  With a constant focus on clinical stability and the importance of being able to manage symptoms for community living, the case manager establishes a trusting relationship with the client/family where there is open dialogue about the need for services and supports. A critical role of the case manager is to provide education to the client/family.  This goes hand in hand with reminders of the need to consider the recommendations of a psychiatrist and/or another medical provider about treatment and services.

A tiered system of Targeted Case Management with authorization processes will detract from the provision of the right level of service.  Mental illness can be cyclic, and the case manager is already required to provide the needed level of support during a crisis.  CSB's are currently providing this service without a cumbersome authorization process.  Case managers currently provide close monitoring of the Medicaid Rehabilitation Services which includes encouragement to participate, problem-solving with the provider, quality assurance, and ongoing discharge planning.  CSB's proudly serve as the single entity to provide Targeted Case Management and are heavily regulated.  Many of the clinical services on the rehab continuum have waiting lists and some of the services are short term in duration.  For these reasons, there are periods of time in which Targeted Case Management is the only service being provided and this is appropriate.   

During the DMAS discussion, some very specific information was provided about Virginia considering a SMI Waiver assessment and the use of the Child and Adolescent Strength and Needs (CANS)/Adult Needs and Strengths Assessment (ANSA) to determine the levels of case management.  It appears that critical decisions may have already been made about the use of these instruments as a component of the Managed Care Organization (MCO) authorization process within a level of care model.