Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

Long-Term Services and Supports

A Primer for Case Managers

Part 1

Treiger, Teresa M., RN-BC, MA, CCM, CHCQM, FABQAURP

doi: 10.1097/NCM.0000000000000331
Articles

Purpose/Objectives: The Centers for Medicare & Medicaid (CMS) announced that, beginning in 2019, Medicare Advantage health plans may begin offering additional benefits for nonmedical home services. In 2019, this change impacts the Long-Term Services and Supports (LTSS) landscape dramatically. This two-part article describes LTSS, its traditional demographic and health care footprint, the regulatory and accreditation landscape, quality measurement and outcomes, and the critical importance of maintaining care continuity for individuals receiving LTSS. The objectives are to:

  • define LTSS,
  • identify client demographics,
  • identify delivery models,
  • discuss regulation and accreditation environments,
  • discuss quality improvement and outcomes initiatives,
  • identify promising practices and best practices, and
  • identify useful resources.

Primary Practice Setting(s): Applicable to all health care sectors where case management is practiced.

Findings/Conclusions: Historically, once Medicare recognizes a product or service, managed health plans and commercial insurance carriers follow suit. Professional case managers must become fluent in the language of LTSS, the implications of these CMS changes, and the impact on case management practice across the care continuum.

Implications for Professional Case Management Practice: Professional case managers should understand LTSS, especially as it pertains to care transitions and continuity of health care services to our most vulnerable clients.

Teresa M. Treiger, RN-BC, MA, CCM, CHCQM, FABQAURP, is an industry-thought leader inspiring Conscious Case Management© practice across the health care continuum through public speaking, professional education, peer mentoring, and publication of professional literature. She is a prolific author in journals, white papers, and courses as well as academic texts, most recently co-editor and author of the CMSA Core Curriculum for Case Management, 3rd ed. (with Hussein Tahan), co-author of COLLABORATE© for Professional Case Management: A Universal Competency Based Paradigm (with Ellen Fink-Samnick), and co-author of Population Health Management, 6th ed., chapter on Leadership and Nursing Case Management (with Ellen Fink-Samnick). Teresa is a past National President of the Case Management Society of America and founding board member of the National Transitions of Care Coalition.

Address correspondence to Teresa M. Treiger, RN-BC, MA, CCM, CHCQM, FABQAURP, Ascent Care Management, 47 Botolph St, Quincy, MA 02171 (teri.treiger@comcast.net).

The author reports no conflict of interest.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.