case management
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Chapter11-RHB30401.pptxRHB 3040 Case Management
Chapter Notes
Chapter Eleven
Liability Insurance
It is always important to be covered no matter what types of services you provide.
It starts with internship(which is why each intern must by student liability insurance)
Once employment occurs under an agency, the employer may have liability insurance. However, each employee needs to confirm coverage.
CM consultations, self-employed and at-risk employees should maintain their own professional liability insurance through a professional organization or reputable company.
Consumer Rights and Confidentiality
Any agency should have a consumer rights and responsibilities form outlining what the consumer can expect while receiving services from the agency or CM. (See CareWorks Example in content)
Each consumer should receive information on privacy, confidentiality and the limitations of confidentiality while receiving services. (See CM Agreement Example for confidentiality)
( p 299-304)
Consent and Disclosure Forms
Consumers need to know and give permission for a CM to request information from (see Consent for release of information example) or disseminate information to (Release of Information HIV example) another party.
Consent forms should be signed to speak with employers, medical personnel, mental health professionals, family members, and any other individual that has information you might need or that the consumer has requested the CM contact with information.
Consumers should also agree to participation (See Program Participation Consent Form)
Consent Form Completion
I always had them on hand as you never know when you will need or want one.
These should be completed during the initial meeting when you are information gathering
Give information verbally and in writing
Offer an opportunity for questions and answers
Witness the signing of the form
Have the legal guardian sign in addition to consumer when necessary (for consumers under 18 or adults under a legal guardian)
Disclosure
There are circumstances in which you must break confidentiality based on court subpoena or duty to warn statue. (p 97) In cases you do have to break confidentiality, it may affect the CM-consumer relationship but less so if you have already gone over the possibility in the initial interview.
As well, if a CM will be speaking with an employer or other party to obtain employment or services, the CM will need to discuss this with the consumer and get permission.
Legal Issues
CM recommendations should control costs and demonstrate appropriate outcomes based on data that can be defended in court.
CM must have the educational and experiential requirements for the position.
CM must have the competence in skills and abilities required for the type of CM provided.
P 308-317
Reviewed Case Implications
CM is a reasonable activity
CM can be held accountable when something bad happens to the client (thus liability insurance)
CM must meet a reasonable standard of care
CM must not conduct their activities in a way corrupts medical judgment
Reviewed Case Implications
CM must act within the scope of their credentials, education and competence
CM are consultants
CM should not practice medicine or interfere with doctor/patient relationships
Alternative treatment plans should be in writing and signed off by the physician.
Appropriate Referrals
CMs, when referring to a facility or provider, should:
Review the facility for competence and qualifications to provide the service
Look at outcomes of similar consumers/populations served
Cost and insurance coverage
I would add:
Eligibility criteria
Ability of client to get there for services
Overall cleanliness and welcoming practices
Laws and CM
CM should be aware of any laws pertinent to his/her consumers.
CM should make it very clear that s/he is not a medical doctor or lawyer and cannot provide advise in those areas.
Documentation is your friend. Be objective!
