长期服务与支持：个案管理员入门指南：第1部分

Long-Term Services and Supports: A Primer for Case Managers: Part 1.

作者信息

Treiger Teresa M

机构信息

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.

出版信息

Prof Case Manag. 2019 Jan/Feb;24(1):4-16. doi: 10.1097/NCM.0000000000000331.

DOI:10.1097/NCM.0000000000000331

PMID:30489468

Abstract

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: 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.

摘要

目的/目标：医疗保险和医疗补助服务中心（CMS）宣布，从2019年开始，医疗保险优势健康计划可能会开始为非医疗家庭服务提供额外福利。2019年，这一变化对长期服务与支持（LTSS）领域产生了巨大影响。这篇分为两部分的文章描述了LTSS、其传统的人口统计学和医疗保健覆盖范围、监管与认证情况、质量衡量与结果，以及为接受LTSS的个人维持护理连续性的至关重要性。目标如下：主要实践环境：适用于所有实施病例管理的医疗保健部门。

研究结果/结论：从历史上看，一旦医疗保险认可了某种产品或服务，管理式健康计划和商业保险公司就会效仿。专业病例管理人员必须精通LTSS的相关内容、CMS这些变化的影响，以及对整个护理连续过程中病例管理实践的影响。