Ch 21: Care Management

Question 1

Domain 1: CM processes and services

Answer 1

Evaluate, assess, plan, facilitate/implement, coordinate, monitor

Question 2

Domain 2: resource utilization and management

Answer 2

Appropriate and beneficial use of healthcare dollars on additional resources/care for pt

Question 3

Domain 3: psychosocial and economic support

Answer 3

Education of the pt and family regarding services, accessibility, financial availability, identify resources/support, assess social supports and caregiver burden, ensure that caregivers are willing and able to assist

Question 4

Domain 4: Rehabilitation

Answer 4

Identification of:

Environmental modifications to address accessibility barriers

Specialized services like Work hardening/return to work programs

Question 5

Domain 5: outcomes

Answer 5

Collection, analysis, and reporting of actual outcome is against expected outcomes

** Quality and effectiveness of outcomes in a variety of areas including clinical, financial, and quality-of-life

Question 6

Domain 6: ethical and legal practices

Answer 6

Adhere to a pertinent regulatory requirements, accrediting standards, and legal requirements

HIPAA

Question 7

Life care plan

Answer 7

Specific to the individual and his/her needs over the course of a lifetime (short and long term)

Reflect a complete understanding of the persons injuries and resultant disabilities

Consider the complications that can occur from sustained injuries and the steps necessary to prevent further complications

Question 8

Social security act of 1935

Answer 8

Provides cash benefits and healthcare plans for individuals who are aged, disabled, and those with low income.

SSDI requirements: sufficient prior work experience to have paid into Social Security system

SSI requirements: Prior work experience not necessary **but only for individuals with very low income/minimal assets

Question 9

4 parts of Medicare

Answer 9

Part A: covers hospitalization, SNF, HHC, and hospice (no cost)

PREMIUMS ARE CHARGED
Part B: covers physician services, outpatient, preventative/lab services, equipment/supplies

Part C: optional cost saving managed care plan

Part D: voluntary Rx drug program

Supplemental ins offered for gaps

Question 10

Medicare eligibility

Answer 10

65+

individuals under 65 with serious disabilities (+work experience)

Question 11

Medicaid

Answer 11

For people with low income, chronic illness, and disabilities who lack private health insurance

**primary payer of long term care for persons who are elderly or have disabilities

• can be used to assist low income Medicare enrollees with their premiums, out-of-pocket costs, and to cover services that Medicare excludes, such as long-term care

Question 12

Omnibus budget reconciliation act of 1981

Answer 12

Home and community based Medicaid waivers

Question 13

State children’s health insurance program of 1997

Answer 13

Covers uninsured children in families with incomes that are modest but too high to qualify for Medicaid

Question 14

Affordable care act

Answer 14

Response to skyrocketing cost of healthcare in the estimated 15 million Americans were uninsured or underinsured

Question 15

Rehab act of 1973

Answer 15

First federal civil rights legislation for people with disabilities because it prohibits discrimination on the basis of disability

Question 16

Section 504 of the Rehabilitation act

Answer 16

Free and appropriate education

children eligible AND not eligible for special education

reasonable accommodations to ensure nondiscrimination and equal access

Question 17

Americans with Disabilities Act of 1990

Answer 17

Prohibits discrimination against a person with a disability in employment, state and local government

mandates public accommodations in commercial facilities, transportation, and telecommunications

Question 18

The olmstead decision

Answer 18

Unnecessary segregation a persons with disabilities in institutions may constitute discrimination based on disability

Provide services for persons with disabilities in the most integrated setting

Question 19

Individuals with disabilities education act of 1990

Answer 19

All American children have a right to free and appropriate education

Question 20

Individualized education program

Answer 20

Describes the students present academic performance and how the students disabilities affect that performance

Question 21

No child left behind act

Answer 21

Provides financial incentives to states to improve their special ed services and services for all students

Question 22

The TBI act of 1996

Answer 22

Grants for research

education on statistics/prevention

Advocacy/public policy

Question 23

Why did mortality rates d/t TBI improve considerably in the 1970s?

Answer 23

Vehicle-related safety improvements and improvements and trauma care