Case Management Policy and Guidance

1. Case Management Policy and Guidance Angela Braithwood, RN, BSN Senior QA Analyst, Case Management Services Skyline Ultd.

2. Objectives • Army Case Management Overview • Policy and Guidance • Training and Education Requirements • CMSA and Certification

3. Army Case Management Model • DoD • Focus on education and training of CM’s • Inclusion Criteria for MND • Army – WTU’s and MMC • Based on CMSA Standards • Core competencies • AC-centric: No reserve component model • National Guard – Varies by State • No official guidance from NGB

4. Warrior Transition Command • Where we all started • Initial concept 1994 • Initial development 2004 • Formalization to WTC in 2005 CPL Kendra Coleman recovers at Walter Reed National Military Medical Center after losing her left leg in Afghanistan

5. Applicable Policies for Case Managers • Case Management Society of America Standards of Practice for Case Management (2010) • CMSA Core Curriculum for Case Management, 2nd Edition. Suzanne K. Powell & Hussein A. Tahan. Philadelphia: Lippincott, 2008 • Department of Defense TRICARE Management Activity Medical Management Guide Version 3.0 • DTM 08-033, Interim Guidance for Clinical Case Management for the Wounded, Ill, and Injured Service Member in the Military Health System • DoDi6025.20, Medical Management • MEDCOM Soldier Medical Readiness Campaign 2011-2016 • HQDA EXORD 118-07, Healing Warriors • MEDCOM OPORD 07-55, MEDCOM Implementation of the Army Medical Action Plan (AMAP) • MEDCOM OPORD 11-20, Patient Centered Medical Home • MEDCOM OPORD 10-66, Medical Management Centers • Comprehensive Transition Plan Guidance

6. DoDi 6025.20 Medical Management (2006) • Establishes Medical Management Care Model within the MHS • Utilization Management • Case Management • Disease Management • Integration and coordination of services • Quality, completeness, and adequacy of total health care • Outcome Management

7. DTM 08-33 (July 2012) • Interim Guidance for Clinical Case Management for the Wounded, Ill, and Injured Service Member in the Military Health System • Originally released Aug 2009 • All-service and component requirements • Basic education, certification, and training • Performance Measures • Documentation/Coding

8. CMSA Standards of Practice • The Professional Organization of Army Case Management

9. TRICARE MMG • Military Health System Guide to Case Management

10. MEDCOM OPORD 13-25 Nursing Case Management Guidance • Consolidation of references • Across all components • 5 lines of effort • CM ID • Training/Education • Performance standards • Quality outcomes/measurement • Strategic communication

11. Army National Guard Case Management • Goal – Reduce Medically Not Ready population to maximize number of Soldiers available for mobilization/deployment • PHA/SRP/SRC Support • LOD/IDES Preparation • Remote Care • Telephonic Case Management • Electronic Database Systems

12. MEDCOM Soldier Medical Readiness Campaign 2011-2016 • Strategic Level Medical Readiness Plan • Population Health • ID, Mgt, Health Promotion • Performance Measures • Commo

13. MEDCOM OPORD 10-66, Medical Management Centers • Closest to what we do at the AC level • Manages MNR Population • Collaboration with Units • Expands use to the RC

14. Triad of Care ARNG WTU • AC based on active, clinical CM • RC based on non-clinical CM

15. ARNG Case Management Environment

16. Training and Education • MHS Learn • Case Management Track • Miliman Ambulatory Care • Core Curriculum • Army CM Course • Essentials of Case Management (fee)

17. MHS Learn Case Management Training

18. Competency Assessment

19. CMSA and Certification • Army prefers Certified Nurse Case Managers. • AC has CCM course for ANC and DA • No RC course/track yet • Fee-based course for all others

20. Questions?

21. Backup/Reference Slides

22. Comprehensive Transition Plan Guidance • WTU Action Plan for Soldiers • Two Tracks • Remain in the Army • Transition out of the Army • Closely tied with MTF’s and PCMH

23. HQDA EXORD 118-07, Healing Warriors • Part of the Army Medical Action Plan (AMAP) • Involvement of all Commands (IMCOM, MEDCOM, etc) • WTU’s more widespread (one at each MTF) • Triad of Care • Soldier and Family Assistance Centers (non-medical) • FRAGOS • 1: Administrative changes to staff visits, add more specific tasks to Chiefs of Staff, adjust focus • 2: SFAC setup • 3: Refining WTU screening and entrance criteria • 4: Reserve Component Remote WTU focus

24. MEDCOM OPORD 07-55, MEDCOM Implementation of the Army Medical Action Plan (AMAP) • Incorporates HQDA EXORD 118-07 tasks to MEDCOM • Tasks RMC’s with AMAP deadlines • Streamlines Soldier and Family transition • Sets up TDA and Unit criteria

25. MEDCOM OPORD 11-20, Patient Centered Medical Home • MHS Primary Care Model • Part of Access to Care Campaign (2008) • 100% direct care enrollees in a PCMH NLT FY 2015 • Utilization Management • Based on NCQA Standards for PCMH

26. The Bible AR 40-501 Standards of Medical Fitness

27. MMPS Case Manager(CM) -reviews case - assigns to Care Coordinator (CC) MRNCO -assist SM w records/profiles - BN monthly report - hand off to CM CC continues to - assist SM CC continues to - assist SM - coordinate w CM/MRNCO as needed - coordinate w CM/MRNCO as needed 0 MO NLT 3 MO NLT 6 MO NLT 9 MO NLT 12 MO Temp profile written (issue found by self report, PHA, PDHA, PDHRA) Case meeting #1CMD/SS/G1 and CM Case meeting #2 CMD/SS/G1and CM Case meeting #3 CMD/SS/G1 and CM MRDP Not reached MRDP ? May get ONE TIME temp prof extension per SS Each case meeting assures: 1)temp profile updated as warranted 2)eval for AD orders for medical care (WTU/RCMC) 3) evalfor MMA assignment (option for CMD) 27

28. Recording Procedures The Physical Performance Evaluation System The Physical Disability Evaluation System A provider determines that a soldier has a medical limiting condition Soldier meets Retention Standards Soldier does not meet Retention Standards Appropriate profile is issued Appropriate profile is issued Medical condition is non-duty related Medical condition is duty related Temporary Profile is issued A Permanent 2 Profile is issued A Permanent 3 Profile is issued Soldier elects a non-duty PEB Soldier is referred to MEB Soldier recovers Soldier is issued a permanent profile PEB - Fit PEB - Unfit Soldier continues with physical disability processing Soldier is referred to MAR2 PEB - Fit PEB - unfit Soldier is retained in MOS Soldier is retained with a change in MOS Soldier is retained with a trial duty Appropriate disability is awarded Legend Medical Action Military Personnel Action Active Component Action MAR2 – MOS Administrative Retention Review MEB – Medical Evaluation Board PEB – Physical Evaluation Board Soldier returns to duty Soldier receives Administrative Discharge