CMSA Today - Issue 1, 2018 - 14

MODEL ACT OVERVIEW
The Model Act establishes the key elements
of a comprehensive case management program that should be implemented at both
the federal and state levels. A primary goal
is to engage public policymakers to review
and use the provisions of this Model Act for
legislative and regulatory initiatives geared
to reducing healthcare costs, improving the
coordination and transitions of care, enhancing quality, and promoting better clinical
outcomes.
The Case Management Model Act is made
up of the following sections:
I. Short Title. Describes the Act in a
summary fashion, i.e., "The CM Model
Act."
II. Definitions. Defines over 20 key terms
used in the Model Act.
III. Staff Qualifications. Identifies the
minimum qualifications for the professional case manager, case management
supervisor and the case management
extender.
IV. Program Requirements. Outlines
key requirements such as the need
for clinical oversight, interdisciplinary
collaboration, written job descriptions
and a formal credentialing verification
process. This section also details the
role and limits of the CM extender, who
works under a case manager.
V. Case Management Program Goals.
Details over a dozen goals for the professional case manager, such as using
a consumer-centric, culturally sensitive
approach to caring for the patient/
consumer.
VI. Authorized Scope of Services.
Reflects most of the activities listed in
CMSA's Standards of Practice, covering:
a. Consumer identification, selection and engagement in case
management
b. Assessment and opportunity
identification
c. Development of the case management plan of care
d. Implementation and coordination of
the case management plan of care
e. Establishing proper caseloads
f. Monitoring and evaluation of the
case management plan of care
g. Closure of the case management
services
VII. Payment of Services. Highlights different payment methodologies for CM
14

CMSA TODAY

services, including an appendix to the
Model Act that provides supplemental
coding guidance.
VIII. Training. Covers orientation and ongoing training requirements for case managers and support staff.
IX. Quality Management. Covers traditional quality management (QM) activities and related documentation.
X. Anti-Fraud & Consumer Protections.
Details key anti-fraud provisions and
consumer safeguards.
XI. Complaints. Summarizes the grievance
procedures, complaint and appeals
process.
XII. R e gulator y
Ove r sight
&
Implementation. Documents which
regulatory agencies are authorized to
implement the Model Act, as well as
the option of "deeming" an accreditation agency for all, or part, of the
provisions in the Model Act.
XIII. Other Program Requirements.
Includes various other provisions
that could be included in the Model
Act including implementation date,
information management, confidentiality requirements and regulatory
compliance.
Ultimately, the Model Act was drafted
in such a way that the legislative language
can be customized to support any particular population health management need or
goal. For example, the Model Act could be
customized to support interventions geared
to support individuals with congestive heart
failure or another serious medical condition
sponsored by Medicare, a state Medicaid
program geared to indigent persons who
need additional transition of care support,
a disability program geared to veterans with
PTSD, a hospital readmission transition program or a program to integrate behavioral
health services into primary care.
WHAT IS NEW
In addition to the 2016 Standards of Practice,
the new Model Act includes a number of
updates, including:
* The definition of "client" was dropped
because of the confusion between patient
and business customers. Instead, the term
"consumer" is used to describe an individual receiving case management services; and "sponsor" is used for the entity
paying for case management services.
* The concept of a "case management

Issue 1 * 2018 * DIGITAL

extender" is introduced and describes
how this support staff can assist a case
manager but not engage in the practice
of case management or nursing.
* The Model Act goes into more detail
regarding the appeals process to assist
a case manager when helping a patient
address a complaint or denial of care.
* More information is provided about how
to pay for case management programs,
including a new section highlighting many
of the new payment codes that are being
implemented.
* A new provision, Section 7.2, was added
on consumer disclosure requirements for
case management services that are either
sponsored programs by a third party
such as a payer, or are consumer-direct
programs.
TIME TO MOBILIZE
In September, CMSA launched a campaign
to share the revised Model Act during the
policy conference in Washington, D.C. As
the professional case management association serving case managers across the
care continuum, CMSA is uniquely prepared
and dedicated to advancing the Model Act.
Greater recognition for case managers is
a necessity - we run clinical practices as
certified professionals - and the acknowledgment of our value and professionalism
is long overdue.
Experiencing 75 professional case managers with the Model Act in hand to meet
with legislators and their health aides was
a sight to see. The opportunity to advocate
and educate for healthcare consumers and
the professional case managers is part of
our civic duty. The next step is to build a
solid relationship with our elected officials
and share our expertise. Now more than
ever is the time for us to fully engage in
public policy activities as healthcare policy
continues to morph into the future. Let's
not let this opportunity pass us by. We are
part of the solution to the current barriers
in the healthcare system.
FINAL THOUGHTS
The time is now to promote the values
and services embedded in the new Case
Management Model Act (revised 2017). In
too many circumstances, other individuals
who are not properly trained or licensed are
allowed to fulfill the role of case managers.
In other cases, case management gets a
bad rap when our services are not defined



Table of Contents for the Digital Edition of CMSA Today - Issue 1, 2018

President’s Letter
Association News
CMSA Corporate Partners
CMSA: Reflection on Achievement and Moving Forward in 2018
Revised Case Management Model Act Promotes National Standards
The National Nurse Act
Changes to the Nurse Licensure Compact (NLC): Critical Information for the Nurse Case Manager
The Reflection of a Professional Case Manager: What Do You See in Your Looking Glass?
Past Presidents Corner
Index of Advertisers
CMSA Today - Issue 1, 2018 - Intro
CMSA Today - Issue 1, 2018 - cover1
CMSA Today - Issue 1, 2018 - cover2
CMSA Today - Issue 1, 2018 - 3
CMSA Today - Issue 1, 2018 - 4
CMSA Today - Issue 1, 2018 - 5
CMSA Today - Issue 1, 2018 - President’s Letter
CMSA Today - Issue 1, 2018 - Association News
CMSA Today - Issue 1, 2018 - CMSA Corporate Partners
CMSA Today - Issue 1, 2018 - CMSA: Reflection on Achievement and Moving Forward in 2018
CMSA Today - Issue 1, 2018 - 10
CMSA Today - Issue 1, 2018 - 11
CMSA Today - Issue 1, 2018 - Revised Case Management Model Act Promotes National Standards
CMSA Today - Issue 1, 2018 - 13
CMSA Today - Issue 1, 2018 - 14
CMSA Today - Issue 1, 2018 - 15
CMSA Today - Issue 1, 2018 - 16
CMSA Today - Issue 1, 2018 - 17
CMSA Today - Issue 1, 2018 - The National Nurse Act
CMSA Today - Issue 1, 2018 - 19
CMSA Today - Issue 1, 2018 - 20
CMSA Today - Issue 1, 2018 - Changes to the Nurse Licensure Compact (NLC): Critical Information for the Nurse Case Manager
CMSA Today - Issue 1, 2018 - 22
CMSA Today - Issue 1, 2018 - 23
CMSA Today - Issue 1, 2018 - 24
CMSA Today - Issue 1, 2018 - 25
CMSA Today - Issue 1, 2018 - The Reflection of a Professional Case Manager: What Do You See in Your Looking Glass?
CMSA Today - Issue 1, 2018 - 27
CMSA Today - Issue 1, 2018 - Past Presidents Corner
CMSA Today - Issue 1, 2018 - 29
CMSA Today - Issue 1, 2018 - Index of Advertisers
CMSA Today - Issue 1, 2018 - cover3
CMSA Today - Issue 1, 2018 - cover4
http://www.nxtbook.com/naylor/CMSQ/CMSQ1118
http://www.nxtbook.com/naylor/CMSQ/CMSQ0417
http://www.nxtbook.com/naylor/CMSQ/CMSQ1417
http://www.nxtbook.com/naylor/CMSQ/CMSQ0317
http://www.nxtbook.com/naylor/CMSQ/CMSQ1317
http://www.nxtbook.com/naylor/CMSQ/CMSQ0217
http://www.nxtbook.com/naylor/CMSQ/CMSQ1217
http://www.nxtbook.com/naylor/CMSQ/CMSQ0117
http://www.nxtbook.com/naylor/CMSQ/CMSQ1117
http://www.nxtbook.com/naylor/CMSQ/CMSQ0416
http://www.nxtbook.com/naylor/CMSQ/CMSQ1416
http://www.nxtbook.com/naylor/CMSQ/CMSQ0316
http://www.nxtbook.com/naylor/CMSQ/CMSQ1316
http://www.nxtbook.com/naylor/CMSQ/CMSQ0216
http://www.nxtbook.com/naylor/CMSQ/CMSQ1216
http://www.nxtbook.com/naylor/CMSQ/CMSQ0116
http://www.nxtbook.com/naylor/CMSQ/CMSQ1116
http://www.nxtbook.com/naylor/CMSQ/CMSQ0415
http://www.nxtbook.com/naylor/CMSQ/CMSQ1415
http://www.nxtbook.com/naylor/CMSQ/CMSQ0315
http://www.nxtbook.com/naylor/CMSQ/CMSQ1315
http://www.nxtbook.com/naylor/CMSQ/CMSQ0215
http://www.nxtbook.com/naylor/CMSQ/CMSQ1215
http://www.nxtbook.com/naylor/CMSQ/CMSQ0115
http://www.nxtbook.com/naylor/CMSQ/CMSQ1115
http://www.nxtbook.com/naylor/CMSQ/CMSQ0414
http://www.nxtbook.com/naylor/CMSQ/CMSQ1414
http://www.nxtbook.com/naylor/CMSQ/CMSQ0314
http://www.nxtbook.com/naylor/CMSQ/CMSQ1314
http://www.nxtbook.com/naylor/CMSQ/CMSQ0214
http://www.nxtbook.com/naylor/CMSQ/CMSQ1214
http://www.nxtbook.com/naylor/CMSQ/CMSQ0114
http://www.nxtbook.com/naylor/CMSQ/CMSQ1114
http://www.nxtbook.com/naylor/CMSQ/CMSQ0413
http://www.nxtbook.com/naylor/CMSQ/CMSQ1413
http://www.nxtbook.com/naylor/CMSQ/CMSQ0313
http://www.nxtbook.com/naylor/CMSQ/CMSQ1313
http://www.nxtbook.com/naylor/CMSQ/CMSQ0213
http://www.nxtbook.com/naylor/CMSQ/CMSQ1213
http://www.nxtbook.com/naylor/CMSQ/CMSQ0113
http://www.nxtbook.com/naylor/CMSQ/CMSQ1113
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0412
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1412
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0312
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1312
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0212
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1212
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0112
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1112
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0411
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1411
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0311
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1311
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0211
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1211
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0111
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1111
http://www.nxtbookMEDIA.com