It often happens that a client's case manager or care coordinator must spend time in collateral contacts--talking with a client's primary or behavioral health caregivers, arranging or following up on appointments, conferring with other providers working with the same client, communicating with potential or current landlords, or making other connections on behalf of the client but without the client being present. These activities are essential if case managers are to fulfill their core function for clients with complex health needs, including those living in PSH. For Medicaid beneficiaries with interacting health and behavioral health conditions, care by a multi-disciplinary team is increasingly acknowledged to be an approach of choice that includes team meetings and case conferences as efficient means of communicating about clients and making ongoing care decisions.69 In many states, Medicaid state plans do not include these activities as covered services, but they could do so, and some do.
When they define the services that are components of a broader service such as rehabilitative services, ACT, or TCM, states may include collateral contacts, team conferences, and case consultation when the client is not present, since these collateral contacts or consultations are for the direct benefit of the Medicaid-eligible individual. For example, TCM services include contacts with ineligible individuals who are directly related to identifying an eligible individual's needs and care for the purpose of helping the eligible individual access services; identifying needs and supports to assist the eligible individual in obtaining services; providing case managers with useful feedback, and alerting case managers to changes in the eligible individual's needs. Collateral contacts are particularly important for the population experiencing chronic homelessness, for whom case managers must make ongoing arrangements.
In addition, case conferences are an essential component of team models of care because they provide an opportunity for team members to share information about a client's needs and functioning, and to collaborate in determining how to provide support most effectively to achieve each client's goals.
Including collateral contacts, case conferencing, and team models of care as components of covered services will help to facilitate and provide reimbursement for the work of service providers who are seeking to integrate and coordinate care, help clients access benefits and community resources, and help clients get and keep housing in the community. They have proven to be especially helpful for clients coming from chronic homelessness and those living in PSH, whose histories of erratic and uncoordinated, but expensive, care have not improved their health outcomes and have left them alienated from many systems of care.