GUIDELINES FOR
COMPLETING THE
NEW TARGETED CASE
MANAGEMENT
SERVICE RECORD
(FORM T107)
EFFECTIVE 10/1/14
As of October 1, 2014, DHHR has required additional paperwork and
has made changes in some of the terminology that has been used in
the past related to the procedure and process for billing Medicaid.
The “Special Education Teacher” is now referred to as a “Targeted
Case Manager” and we have to receive permission from the
parents/guardian or student if they are 18 years of age or older in
order to become the student’s Targeted Case Manager, this new
Acknowledgement Form has to be obtained once a year.
The other major change that has happened is with the form T2022,
Care Coordination Service Record, it is now being replaced with
form T107, Targeted Case Management Service Record. There are
now 7 activities to choose from instead of 24 that were on the
previous form and documentation (progress notes) are now
required for every activity that is provided during the month for that
student. The Director of Special Education along with the
Supervisors have compiled a list of examples that could be used for
the new 7 activities plus a description of each of the activities.
Below is a list of all the new activities and descriptions along with
examples of documentation that can be used to complete the
progress notes.
A - Assessment: The case manager ensures an on-going formal and informal
process to collect and interpret information about student’s strengths,
needs, resources and life goals. This process is used in the development of
an individualized education program (IEP)/Service Plan.
A1. Gathered information from the student’s records and from related
service providers to be used in the development of the IEP present levels of
academic achievement and functional performance (PLAAFP).
A2.Participated in an eligibility meeting that provided information towards a
student’s academic and functional performance in determining the
student’s educational IEP/ Service needs.
A3.Assessed/ reviewed student’s assessment data such as classroom
performance, WESTEST data, STAR, Woodcock-Johnson III, benchmark
assessments and discipline data to be used in the development of the IEP’s
Present Levels of Academic Achievement and Functional Performance
(PLAAFP).
A4.Gathered and analyzed data collection on student's IEP goal
performance and behavioral data to develop/revise the IEP present levels of
academic and behavioral achievement and functional performance.
A5.Gathered and analyzed behavioral data on student's target behaviors
included in the behavior intervention plan to monitor the students plan to
determine if it is continuing to address the student's behavioral needs.
A6.Gathered information from the classroom teacher regarding student’s
communication skills in the classroom.
A8. Completed an observation to gather informal evaluation data to be used
in the development of the IEP present levels of academic achievement
and functional performance.
A9. Scored student evaluations to be used in the development of the IEP
present levels of academic achievement and functional performance
B - IEP/Service Planning: The case manager ensures and facilitates the
development of a comprehensive, IEP/Service Plan.
B1. Completed and sent the IEP meeting notice to the IEP Team to prepare
for the development of an IEP as related to medically/educationally
necessary services. The meeting notice will serve to advise providers to
prepare reports on the student’s progress on his IEP goals.
B2.Completed Interest Inventories and student surveys to prepare for the
development of the students transition services and post- secondary goals
to incorporate appropriate scheduling within their chosen career pathway.
B3. Reviewed current progress notes/therapy logs to prepare for the
development of an IEP as related to medically necessary services.
B4. Conferred with General Education Teacher on student’s academic and
communication progress to prepare for the development of an IEP as
related to medically/educationally necessary services.
B5. Conducted a meeting with all student’s providers to develop the
IEP/Service Plan.
intervention plan that includes proactive and reactive strategies to assist in
decreasing the frequency and severity of maladaptive behaviors.
B6. Developed a “draft” IEP/Service Plan that incorporated student
academic strengths and weaknesses along with
modifications/accommodations that enhances student achievement and
success.
C5. Met with General Education teacher and administrator to monitor
student progress and update current accommodations/modifications.
B7.Contacted IEP team members to coordinate multiple disciplinary
members for participation and input in the development of a
comprehensive individualized educational service plan as related to
medically necessary services.
B8.Contacted and met with the special needs nurse to prepare for the
development of the Health Care Plan and for the development of an
individualized educational service plan as related to medically necessary
services.
C - Linkage/Referral: The case manager ensures linkage to all internal and
external services and supports identified in student’s IEP/Service Plan
related to medically necessary service (PT, OT, ST, Health Care Plan, and
Behavior Intervention Plan.
C1. Conferred with the school nurse about health issues related to the
student’s medical services/ needs necessary for the development of a
Health Care Plan.
C2. Conferred with the school psychologist regarding Functional Behavior
Assessment results to determine an appropriate Behavior Intervention Plan
as it relates to medically /educationally necessary services.
C3. Conferred with administration on resources for behavior intervention as
related to medically necessary services. Referred student to the
recommended behavior interventionist to assist student with developing
coping skills for anxiety and anger.
C4. Conferred with the county level program supervisor on assistance for
behavior intervention related to medically necessary services. Requested
observation and support to assist with the development of a behavior
C6. Met with school counselor to monitor student progress and update
current accommodations/modifications.
C7. Completed documentation from outside agencies such as physicians,
psychologists, audiologists.
C8. Conferred with the county level program supervisor and the school
administrator on assistance for related therapies (Occupational Therapy,
Physical Therapy, and Speech Therapies) to assist the student accessing the
educational environment.
D - Advocacy: The case manager’s advocacy refers to the actions
undertaken on behalf of the student in order to ensure continuity of
services, system flexibility, integrated services, proper utilization of facilities,
and resources and accessibility to services.
D1. Advocated for student with administration to assure student has a nurse
for health services to travel with student on class field trip.
D2. Advocated for student with the administration to assure student
receives appropriate disciplinary action for the inappropriate behavior
displayed.
D3. Advocated for student with the IEP Team to incorporate counseling
services needed for inappropriate behaviors through development of
coping/social skills.
D4.Advocated for the student with administration on the need for support
and preferred seating in all school assemblies, cafeteria and auditorium
seating, and all other performances.
D5.Advocated for the student with the speech language pathologist
regarding the student's services and treatment to increase the student's
ability to communicate the student's wants, needs and communicate health
related issues.
D6. Consulted with outside therapy provider to coordinate and provide a
continuity of services.
D7. Consulted with audiologist to explore various resources and services for
student who is deaf/hard of hearing.
D8. Developed a home communication plan to encourage progress and
generalization of speech goals.
E - Crisis Response Planning: The case manager must ensure that adequate
and appropriate crisis response procedure(s) and accessibility are available
to the student and identified in the IEP/Service Plan
E1. Student was involved in an activity with classmates when she began to
exhibit physical aggression toward another student. The physical aggression
was using a hand with a closed fist to hit the other student making a forceful
contact. Intervened according to behavior intervention plan. (Describe the
intervention.)
E2. Worked with crisis team to develop a Behavior Intervention Plan.
E3. Documented physical intervention utilized during Crisis Intervention.
E4. Student was involved in the development of a Behavior Intervention
Plan with the case manager that outlined disciplinary steps to be taken and
assured student ownership of the Behavior Intervention Plan and Crisis
Response procedures.
E5. The case manager reviewed the Behavior Intervention Plan and Crisis
Response procedures, for the student, with the administration, service
personnel, and school staff to ensure that adequate and appropriate Crisis
Response procedures are followed.
E6.Student was engaged in instruction when the student became anxious,
and exhibited self-stimulating behaviors. Behaviors included pacing, rocking
back and forth, flapping and hand wringing. Provided the student with
calming strategies included in the student’s behavior intervention plan and
sensory diet.
E7. Student became aggressive when included in the general education
setting. Student began screaming, throwing objects and physically
aggressing toward others (pushing). Intervened by implementing CPI
transport procedure to remove the student from the audience and relocate
to a more calm location.
F - IEP Evaluation: The case manager continually evaluates the
appropriateness of the student’s IEP/Service Plan and makes appropriate
modifications, establish new linkages, or engage in other dispositions as
necessary related to medically necessary service (PT, OT, ST, Health Care
Plan,)
F1. Monitored student progress through the development of progress notes
that are sent home to parents.
F2. Followed up with general educator on student academic and/or
behavioral performance and modifications to ensure student’s goals and
objectives are being implemented.
F3. Conducted a formative assessment of the student’s needs with the
student to determine appropriateness of her IEP. No modifications need to
be made to the IEP at this time. She is making progress in her goals.
F4.The case manager reviewed and progress monitored the student’s IEP
goals and sent a copy to the parent documenting progress/or lack of
progress towards each goal.
F5. Conferred with classroom teachers to determine if target
communication skills are being generalized in the school environment.*
F6. Conferred with parents to determine if target communication skills are
being generalized in the home environment.*
*These could be changed to focus on behavior.
F7. The case manager reviewed the student’s modifications/
accommodations to ensure they are appropriate for the student’s academic
achievement and functional performance.
F8. Monitoring and Follow Up: The case manager monitors and follows up
on one of the above stated components.
F9. The case manager followed up with the student and the general
classroom teacher on the student’s progress toward academic achievement.
F9.The case manager followed up with administration and classroom
teachers the student’s behavior/ disciplinary
F10.Conducted an assessment of the student's needs in regards to hygiene
and independence in the bathroom as addressed in the IEP. No modification
is needed to IEP adaptive goals at this time. Student continues to progress
towards independence.
F11.Assessed the student's ability to interact and socialize with peers in the
general education setting. Student continues to struggle with maintaining
eye contact, sustaining a conversation with age appropriate interaction and
initiate conversations with same aged peers. Continued instruction,
scripting and modeling needed to address IEP goals. No modification to
goals is needed at this time. Student continues to make progress on goals,
G - Monitoring and Follow Up: The case manager monitors and follows up
on one of the above stated components.
G1. Followed up with the student and the general classroom teacher on the
student’s incident of physical aggression toward another student. Will
convene the IEP Team to review the appropriateness of the behavior
intervention plan.
G2.The case manager followed up with the student and the general
classroom teacher on the student’s progress toward academic achievement.
G3. The case manager followed up with administration and classroom
teachers the student’s behavior/ disciplinary referrals towards meeting
student’s behavior goals.
G4.Followed up with the occupational therapist on the student's sensory
needs and sensory diet. Occupational Therapist will review current sensory
diet to review the appropriateness of the sensory diet.
G5.Followed up with speech therapist regarding the student's expressive
communication. Speech Therapist will review current expressive
communication for appropriateness and ability to communicate wants and
needs. Will review IEP goals to insure that functional communication is
being addressed throughout school day.
G6.Followed up with the occupational therapist on the student's sensory
needs and sensory diet. Occupational Therapist will review current sensory
diet to review the appropriateness of the sensory diet.
G7.Followed up with speech therapist regarding the student's expressive
communication. Speech Therapist will review current expressive
communication for appropriateness and ability to communicate wants and
needs. Will review IEP goals to insure that functional communication is
being addressed throughout school day.
G8. Conferred with classroom teachers to determine if target
communication skills are being generalized in the school environment.
G9. Conferred with parents to determine if target communication skills are
being generalized in the home environment. Generalization in all
environments benefits the student’s outcomes.
G10. Conferred with classroom teachers to determine if target behavior
skills are being generalized in the school environment.
G11. Conferred with parents to determine if target behavior skills are being
generalized in the home environment.
At the end of the month all of the targeted case management
service records need to be turned in just like the care coordination
service records were along with all of the progress notes for each
student.
Hopefully, these new guidelines and examples will be helpful to you
in completing the new forms that are now required.
Any questions always feel free to e-mail me at bsnell@k12.wv.us or
telephone me at 304-528-5019. We want to make this transition of
new procedures as easy as possible.