case management policy and guidance n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Case Management Policy and Guidance PowerPoint Presentation
Download Presentation
Case Management Policy and Guidance

Loading in 2 Seconds...

play fullscreen
1 / 28

Case Management Policy and Guidance - PowerPoint PPT Presentation


  • 950 Views
  • Uploaded on

Case Management Policy and Guidance. Angela Braithwood, RN, BSN Senior QA Analyst, Case Management Services Skyline Ultd. Objectives. Army Case Management Overview Policy and Guidance Training and Education Requirements CMSA and Certification. Army Case Management Model. DoD

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

Case Management Policy and Guidance


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
    Presentation Transcript
    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