Case Managers can use their voices to influence public policy at the State and Federal levels. By being a member of the Case Management Society of America, you can learn how to get involved. Here is a link to the National Office   Public Policy page. Visit it often to be updated on what is happening on the National Level https://cmsa.org/public-policy. 

10.1.24: CMSA has added three new position papers for your use. Please take time to download them and share them with your colleagues and patients. 

Our position papers and statements serve as essential resources for case managers, healthcare professionals, and organizations striving to improve patient care and outcomes. Additionally, our fact sheets offer accessible overviews of how case management can enhance healthcare experiences and system-wide efficiency. Explore our collection to stay informed and empowered with the latest in case management practices and standards. 

1. Promiting Successful Outcomes in Making Care Primary: The Role and Value of Case Management. Here is a link to download the paper:  https://cmsa.org/promoting-successful-outcomes-in-making-care-primary 

2. Communicating Your Value: The Case Manager’s Guide. Here is the link to download the Paper: https://cmsa.org/cmsa-cfcm-position-paper-2023.

3. The Impact of Case Management on the Healthcare System. Here is a link to download the paper: https://cmsa.org/case-management-at-a-glance

A vital settlement that all case Managers need to know about Patients ability to get services for long term: 

In the case of Jimmo v. Sebelius, the Center for Medicare Advocacy (CMA) alleged that Medicare claims involving skilled care were being inappropriately denied by contractors based on a rule-of-thumb “Improvement Standard”—under which a claim would be summarily dismissed due to a beneficiary’s lack of restoration potential, even though the beneficiary did require a covered level of skilled care to prevent or slow further deterioration in their clinical condition.
In the Jimmo lawsuit, CMS denied establishing an improper rule-of-thumb “Improvement. Standard.” The Court never ruled on the validity of the Jimmo plaintiffs’ allegations. Health and Human Services Proposes Minimum Staffing Standards to Enhance Safety and Quality in Nursing Homes. To learn more, visit https://www.cms.gov/medicare/medicare-fee-for-service-payment/snfpps/downloads/jimmo_fact_sheet2_022014_final.pdf.

Have you had a patient or a family in a nursing home? Was the care good? What was your experience? Recently, HHS has called for minimum staffing levels in nursing homes. Nurses and nurses aids are understaffed and under-appreciated. Take a few minutes to read the proposed rule. I would also ask you to use the public comment period to provide your expertise. This is a critical time as the baby boomers move into the at-risk age group, which will stress the current nursing home system. 

Here is the message from CMS: https://www.cms.gov/newsroom/press-releases/hhs-proposes-minimum-staffing-standards-enhance-safety-and-quality-nursing-homes

Also, here is the information for the Public Comment period. https://acl.gov/news-and-events/announcements/public-comment-period-now-open-cms-nursing-home-minimum-staffing 

Florida Case Managers/Patient Advocates Use Their Voices for Change During COVID

For Florida Advocates, public policy affords as many opportunities to raise issues and make recommendations to improve care delivery in our State.

This article shows how one Patient Advocate used her voice and actions to change policy in nursing homes during COVID. https://www.today.com/health/mary-daniel-works-dishwasher-see-husband-nursing-home-t186518  As a result of her work, Mary and other citizens worked with Governor DeSantis and his team to pass the Essential Care Giver Act that allowed people in nursing homes to have visitors and not be banned from seeing them. The legislation is known as the “NO Patient Left Alone Act.” The Act was signed into law in Florida on April 6, 2022. Gov. DeSantis signs’ No Patient Left Alone Act’ | WFLA  

As a result of this action in Florida, there is now a House Bill on the National Level titled “Essential Care Giver Act.” This Act will allow every resident to have two essential caregivers who can be with them following the same safety protocols as staff. Here is a link to the House Version: Text – H.R.2114 – 117th Congress (2021-2022): Essential Caregivers Act of 2021 | Congress.gov | Library of Congress

What is happening in the State of Florida regarding Public Policy? 

In the State of Florida, many issues impact the people who we care for. As a member of the All Florida Case Management Network, we would like to hear about the problems and challenges you see and ideas on improving the process. 

One issue that arose in my practice was with a patient who had a bilateral amputation. Postoperatively, she was recommended to get a prosthesis. The company did the evaluation but said that the Medicaid Codes were insufficient to pay for the work that went into making the prosthetics. The patient was on Medicaid. At my insistence, the company moved forward with the prosthetic but took a massive loss as the Florida Medicaid Fee Schedule was incomplete. The company said they have run into this issue repeatedly and have not received the necessary codes. 

To address this, we are looking to meet with Medicaid Representatives to discuss the missing codes so that companies that provide prosthetics, especially upper body prosthetics, have the necessary regulations in the fee schedule. 

If you want to join us, please email Anne Llewellyn at allewellyn48@gmail.com. We are planning a meeting in September 2023 to discuss the project and make plans to visit the appropriate office to address the issue. Providers, Health Systems, Payers, and case managers from all settings are welcome to participate. 

If you have a topic you would like to bring to the Public Policy Committee, please email Anne Llewellyn, and we can discuss it to see what we can do!