CMSA Today - Issue 2, 2011 - (Page 42)

CMSA Case Management and the Law Case Management Standards & Sound Regulation Promoting Practice That Produces Results GARRY CARNEAL, JD, MA he case management community has done a wonderful job promoting “individual” standards of practice that ensure the integrity and consistency of medical management services. However, promoting “organizational” guidelines for case management services has been historically more of a challenge. The good news is that the Case Management Society of America (CMSA) and its membership have taken a leadership role to ensure organizations supporting private-sector and public-sector case management (CM) programs meet or exceed baseline quality, clinical, and legal requirements. Here are two examples that highlight CMSA’s proactive thinking. T accreditation program similar to its UM accreditation program to ensure that health plans and other organizations sponsoring CM services were following quality-based processes. The rest, as they say, is history. Since the launch of URAC’s CM Accreditation Program in 1999, URAC has accredited hundreds of organizations. In addition, CMSA continues to assume a leadership role with URAC as it has revised and enhanced the CM standards over the years. URAC’s standards now serve as the nationally accepted quality benchmark for organizations offering CM services. CMSA’S CM MODEL ACT Unfortunately, the adoption of effective and consistent regulations governing organizations offering CM services is still hit or miss. In fact, several bills proposed in recent years would actually undermine the integrity of case managers. For example, the concept of a “patient navigator” has emerged in many federal and state bills that could empower unqualified individuals to provide case management services. As a result, CMSA has taken its concerns to Congress, state legislatures, and other public policy forums to ensure that only trained and properly licensed professionals may work directly with patients to help coordinate care and related CM activities. This is not simply about protecting the profession of case management – it is about ensuring that the best interests of the patient are met, consistently and effectively. One of the vehicles CMSA has used to carry its message to Congress and federal agencies is the Case Management Model Act. In 2009, CMSA’s Board approved that model law, which helps identify the key elements of a comprehensive CM program that ultimately should be implemented through governmentsponsored or government-funded programs. I encourage you to download a copy of the Model Act from CMSA’s website. And let me know what you think. ■ URAC’S CM ACCREDITATION PROGRAM Not long after I became the President and CEO of URAC in the mid-1990s, I realized there was much more going on in the medical management system than just utilization management (UM). The emerging role and importance of CM services in addressing a variety of population-based needs was surfacing. At that time, however, few states had adopted comprehensive enabling legislation or regulations to govern case management services (in a way that states had for utilization management), nor had any of the other accreditation organizations adopted stand-alone case management standards. As a quick aside, a regulatory survey completed in 2002 by URAC and CMSA highlighted that more than 7,300 state and federal regulatory requirements had been adopted to help govern case management services. Most of these statutes and regulations, though, represented an ad hoc or limited approach to overseeing how case management services are offered. See, Case Management Trends: An Overview of Recent Industry and Regulatory Developments (URAC/CMSA, 2002). With CMSA’s support, it took the better part of a year to convince URAC’s board that we needed to develop a CM About the Author Garry Carneal is President & CEO of Schooner Healthcare Services. Send comments to Author’s note: I look forward to highlighting in subsequent editions of CMSA Today the latest legal and regulatory trends that are or will have an impact on case management. 42 CMSA TODAY Issue 2 • 2011

Table of Contents for the Digital Edition of CMSA Today - Issue 2, 2011

CMSA Today - Issue 2, 2011
Table of Contents
Outgoing President’s Letter
Incoming President’s Letter
How Care Coordination Affects You
Demonstrating Case Management’s Value to Hospitals’ Bottom Line
Making the Case for Evidence-Based Case Management Practice and Programs
Association News
Ask the Expert
Facility Profile
View From Capitol Hill
Case Management and the Law
Ethics Casebook
Mentoring Matters
Index of Advertisers

CMSA Today - Issue 2, 2011