410-138-0060 Targeted Case Management Program — Provider Requirements (1) TCM Public Health Nurse Home Visiting (Babies First!, CaCoon, and Nurse-Family Partnership) targeted case managers may be an employee of a Local Public Health Authority or other public or private agency contracted by a Local Public Health Authority with the demonstrated ability to meet all state and federal laws governing the participation of providers in the state Medicaid program and the ability to provide data to the Family and Child Health (FCH) Data System. (2) TCM services provided under the Universally Offered Newborn Nurse Home Visiting Program as defined in Public Health 333, Division 6 Newborn Nurse Home Visiting must be provided by certified providers. (3) TCM Federally Recognized Tribal Governments providers shall be Indian Health Services/638 facilities. (4) All providers shall demonstrate the ability to provide all core elements of case management services including: (a) Comprehensive assessment, which may include triage and environmental assessment of client needs; (b) Reassessment of the client’s status and needs annually or more frequently with a significant change in the client’s condition; (c) Development and periodic revision of a comprehensive care and service plan; (d) Referral and linking/coordination of services; (e) Ongoing monitoring and follow-up of referral and related services; (f) A financial management capacity and system that provides documentation of services and costs and provides computerized tracking and monitoring to assure adequate follow-up and avoid duplication. (5) Except for Federally Recognized Tribal Governments and the Newborn Nurse Home Visiting Program, the TCM provider shall provide the non-federal matching share from public funds in compliance with OAR 410-138-0005. (6) If the provider is a subcontractor of a governmental entity, the governmental entity shall make the non-federal matching share with public fund payments in compliance with OAR 410-138-0005. (7) All program providers shall demonstrate the following TCM experience and capacity: (a) Understanding and knowledge of local and state resources and services available to the target population; (b) Demonstrated case management experience in coordinating and linking community resources as required by the target population; (c) Demonstrated and documented experience providing services for the target population; (d) An administrative capacity to ensure quality of services in accordance with state and federal requirements; (e) A financial management capacity and system that provides documentation of services and costs; (f) Capacity to document and maintain client case records in accordance with state and federal requirements, including requirement for recordkeeping on OAR 410-138-0007 and 410-120-1360; confidentiality requirements in ORS 192.518–192.524,179.505 and 411.320; and HIPAA Privacy requirements applicable to case management services; (g) A sufficient number of staff to meet the case management service needs of the target population; (h) Demonstrated ability to meet all state and federal laws governing the participation of providers in the state Medicaid program; and (i) Enrolled as a TCM provider with the Authority and meeting the requirements set forth in the provider enrollment agreement. (8) The TCM case managers for the Public Health Nurse Home Visiting, Babies First!, CaCoon, and Nurse-Family Partnership programs: (a) May be an employee of a local public health authority or other public or private agency contracted by a Local Public Health Authority; (b) Shall be a licensed registered nurse with experience in community health, public health, or child health nursing; and (c) May be a community health worker working under the plan developed by a licensed registered nurse. The minimum qualifications of the Community Health Workers are as follows: (A) High School Graduate or GED with additional course work in human growth and development, health occupations, or health education; and (B) Two years’ experience in public health, mental health, or alcohol drug treatment settings; or (C) Any satisfactory combination of experience and training that demonstrates the ability to perform case management duties; (D) The case manager shall work under the policies, procedures, and protocols of the state FCH Section. (9) The TCM case managers for the Newborn Nurse Home Visiting Program must be a licensed registered nurse and an employee of a certified NNHV provider as defined in Public Health 333, Division 6 Universally Offered Newborn Nurse Home Visiting Program. The case manager shall work under the policies, procedures, and protocols of the state FCH Section. (10) TCM HIV providers shall have the financial management capacity and system that provides documentation of services and costs and is able to generate quarterly service utilization reports that can be used to monitor services rendered against claims submitted and paid. The service utilization reporting requirements are as follows: (a) Report on the number of unduplicated clients receiving services during the reporting period; (b) Report on the number of full time equivalent (FTE) case managers providing services during the reporting period; and (c) Report on the number of distinct case management activities performed during the reporting period (Triage Assessments, Comprehensive Assessments, Re-Assessments, Care Plan Development, Referral and Related Services, and Monitoring Follow-Up) along with the total number of 15-minute increments associated with each activity category. (11) TCM HIV case managers shall possess the following education and qualifications: (a) A current active Oregon registered nurse (RN) license or Bachelor of Social Work, or other related health or human services degree from an accredited college or university; and (b) Documented evidence of completing the Authority’s HIV Care and Treatment designated HIV Targeted Case Manager training and shall participate in the Authority’s on-going training for HIV targeted case managers. The training may either be provided by the Authority or be approved by the Authority and provided by the TCM provider organization. (12) A Federally Recognized Tribal Governments TCM provider shall be an organization certified as meeting the following criteria: (a) A minimum of three years’ experience of successful work with Native American children, families, and elders involving a demonstrated capacity to provide all core elements of tribal case management including: assessment, case planning, case plan implementation, case plan coordination, and case plan reassessment; (b) A minimum of three years case management experience in coordinating and linking community medical, social, educational, or other resources as required by the target population; (c) Administrative capacity to ensure quality of services in accordance with tribal, state, and federal requirements; and (d) Evidence that the TCM organization is a federally recognized tribe located in the State of Oregon. (13) The following are qualifications of Tribal Case Managers within provider organizations: (a) Completion of training in a case management curriculum; (b) Basic knowledge of behavior management techniques, family dynamics, child development, family counseling techniques, emotional and behavioral disorders, and issues around aging; (c) Skill in interviewing to gather data and complete needs assessment in preparation of narratives/reports, in development of service plans, and in individual and group communication; (d) Ability to learn and work with state, federal and tribal rules, laws and guidelines relating to Native American child, adult, and elder welfare and to gain knowledge about community resources and link tribal members with those resources; (e) Knowledge and understanding of these rules and the applicable Medicaid State Plan Amendment. (14) Providers delivering Reentry Targeted Case Management services as part of Reentry FCAA Services as described in OAR 410-155-0010 must meet the following requirements: (a) Be a licensed practitioner working within the scope of practice as defined by state law, including but not limited to, a Physician as defined in ORS 677.010, a Nurse Practitioner licensed under ORS 678.375, a Registered Nurse licensed under ORS 678.021, 6780.040, 678.279 or 678.370; or (b) Be a Behavioral Health Clinician as defined in ORS 414.025; or (c) Be a QMHP or QMHA as defined in OAR 309-019-0105; or (d) Be a Certified Alcohol and Drug Counselor (CADC), Certified Alcohol and Drug Counselor Candidate (CADC-R), or Certified Gambling Addiction Counselor (CGAC) as defined in OAR 309-083-0010; or (e) Be a Master’s Social Worker licensed under ORS 675.533 or a board registered Baccalaureate Social Worker per ORS 675.523; or (f) Possess certification through the Oregon Health Authority Office of Equity and Inclusion as a Traditional Health Worker and; (A) Work under the supervision of a licensed clinician; or (B) Are an employee of a CCO; or (C) Are an employee of a Medicaid-enrolled public or private agency, inclusive of Local Public Health Authorities, with the demonstrated ability to meet all state and federal laws governing the participation of providers in the state Medicaid program. (g) Work in compliance with Medicaid policies, procedures, and protocols as described in OAR 410-141-3510. (15) Oregon Youth Authority TCM provider organization shall meet the following requirements: (a) A minimum of three years of successful experience working with children and families—including demonstrated capacity in assessment, care planning, implementation, coordination, and reassessment. (b) At least three years of experience coordinating community medical, social, educational, or other resources for the target population. (c) Administrative capacity to ensure quality of services and compliance with state and federal standards. (d) Financial management systems sufficient to document services and associated costs. (e) Recordkeeping systems consistent with state and federal requirements for individual case records. (f) Demonstrated commitment to ensuring freedom of choice for eligible individuals, in accordance with 42 CFR 441.18(a)(1) and section 1902(a)(23) of the Social Security Act. (16) Oregon Youth Authority TCM case managers shall meet the following requirements: (a) Completion of case management training. (b) Foundational knowledge in behavior management, family dynamics, child development, counseling, and emotional or behavioral disorders. (c) Proficiency in interviewing, needs assessment, narrative/report writing, service planning, and both individual and group communication. (d) Ability to navigate court systems, understand applicable rules and laws, and maintain familiarity with community resources. Statutory/Other Authority: ORS 413.042 & 414.065 Statutes/Other Implemented: ORS 414.065 History: DMAP 98-2025, amend filed 12/29/2025, effective 01/01/2026 DMAP 58-2022, amend filed 06/21/2022, effective 06/22/2022 DMAP 51-2021, temporary amend filed 12/28/2021, effective 01/01/2022 through 06/29/2022 DMAP 13-2020, amend filed 03/24/2020, effective 03/27/2020 DMAP 9-2017, f. 3-31-17, cert. ef. 4-1-17 DMAP 4-2017(Temp), f. 2-2-17, cert. ef. 2-10-17 thru 7-11-17 DMAP 2-2017(Temp), f. & cert. ef. 1-13-17 thru 7-11-17 DMAP 76-2016, f. 12-29-16, cert. ef. 1-1-17 DMAP 41-2010, f. 12-28-10, cert. ef. 1-1-11 DMAP 22-2010, f. 6-30-10, cert. ef. 7-1-10 OMAP 50-2004, f. 9-9-04, cert. ef. 10-1-04 HR 37-1994, f. 12-30-94, cert. ef. 1-1-95 HR 20-1992, f. & cert. ef. 7-1-92