Persons applying for TCM services shall meet the following eligibility criteria:
1. The individual is age 18 or over and has a primary diagnosis of mental retardation, developmental disability, or chronic mental illness.
2. The individual is receiving Medicaid benefits.
3. The individual is under the age of 18 and is receiving services through the Home and Community Based Services (HCBS) Intellectual Disability or Brain Injury Waiver program.
If you meet the eligibility criteria for TCM services you may be entitled to the service; however, you may not be appropriate for the service offered. In order to be accepted for services you will need to meet the following criteria:
1. You will meet the eligibility as previously stated.
2. You have been determined to have legal settlement in Dallas County. If the county of legal settlement has been determined to be a county other than Dallas County, the case manager will obtain approval from that County’s CPC for TCM services. Residents of Dallas County will not be denied due to disputed legal settlement issues.
3. You must want the service and agree to participate in the ICP process.
4. If you refuse to participate in any aspect of the ICP development or implementation, you may be discharged.
5. There must be a defined need for TCM services. All Medicaid funded services are based on a level of need or medical necessity. For the purposes of case management, you will have a need and want services coordinated, referrals made and/or monitoring of services.
a) If the IDT is unable to identify any service needs, the consumer may be discharged. Examples of situations which may warrant discharge are:
(1) If you are “stable” in their current placements, and have no desire for movement to a less restrictive setting may not be appropriate for service.
(2) When you are in the least restrictive setting, and no additional services or supports are planned or requested, there may not be a need for case management services.