ACA CCM cheat sheet

Case management process sequence: intake/screening, assessment, problem identification, care planning, implementation, monitoring, evaluation, and case closure/transition.

Case management is a collaborative process; the client's self-determination governs goal selection, not the case manager's preference.

Assessment domains typically include medical/physical, functional, psychosocial, financial, environmental, and support-system status.

Care plans require measurable, time-bound goals with assigned responsibility for each intervention.

Caseload standards are not fixed by law; they are set by employer policy, acuity, and payer contract.

Transition/discharge planning begins at intake, not at the end of service.

Monitoring compares actual outcomes against plan goals; evaluation judges whether goals were met or the plan needs revision.

Documentation of each contact should reflect date, participants, interventions, client response, and next steps.

Maslow's hierarchy orders needs: physiological, safety, belonging/love, esteem, self-actualization; lower needs generally precede higher.

Stages of change (Prochaska): precontemplation, contemplation, preparation, action, maintenance, and relapse is a normal part of the cycle.

Motivational interviewing uses open questions, affirmations, reflective listening, and summaries to build change talk.

Grief stages (Kübler-Ross) are not linear or mandatory; denial, anger, bargaining, depression, acceptance are common reactions.

Mental status exam elements: appearance, behavior, speech, mood/affect, thought process/content, cognition, insight, judgment.

Depression screening commonly uses the PHQ-9; anxiety screening commonly uses the GAD-7.

Substance use screening commonly uses AUDIT-C or CAGE; a positive screen requires further assessment, not diagnosis.

Suicide risk assessment addresses ideation, plan, intent, means, prior attempts, and protective factors.

Medicare Part A covers inpatient hospital, skilled nursing facility, hospice, and some home health; Part B covers outpatient and physician services.

Medicare Part D covers prescription drugs; Medicare Advantage (Part C) is managed care through private plans.

Medicaid is jointly funded by federal and state governments and is administered by states with variable eligibility.

Managed care models include HMO, PPO, POS, and EPO; prior authorization and network rules differ by model.

Utilization management tools include preauthorization, concurrent review, retrospective review, and case or disease management.

Levels of care range from inpatient acute through subacute, skilled nursing, assisted living, home care, and outpatient.

COBRA allows continuation of group health coverage for limited periods after qualifying events, with the enrollee paying the premium.

HIPAA privacy rule permits disclosure for treatment, payment, and operations without authorization; other uses require authorization.

Rehabilitation settings include inpatient rehab facilities, skilled nursing, outpatient therapy, home health, and day programs.

Functional assessment tools include the Functional Independence Measure (FIM) and the Barthel Index, both measuring activities of daily living.

Home and community-based services (HCBS) waivers fund services that let people remain in community settings rather than institutions.

Community resource categories: housing, transportation, food assistance, vocational services, peer support, and legal aid.

Americans with Disabilities Act requires reasonable accommodations and accessible public accommodations.

Individualized Education Program (IEP) under IDEA provides special education services for eligible students ages 3-21.

Vocational rehabilitation services include assessment, job training, placement, and assistive technology.

Resource referral requires confirming eligibility, availability, cost, and client consent before sharing information.

Informed consent requires capacity, disclosure of risks and benefits, understanding, and voluntariness.

Confidentiality exceptions include suspected abuse/neglect, imminent danger to self or others, and court order.

Mandatory reporting laws require reporting suspected child abuse, elder abuse, and dependent adult abuse to designated agencies.

Ethical principles: autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity.

Dual relationships should be avoided when they risk impairing professional judgment or exploiting the client.

Advance directives include living wills, durable power of attorney for healthcare, and DNR orders.

Scope of practice is defined by state licensure law and employer policy; acting outside it creates liability.

Release of information requires written, time-limited, specific authorization naming the recipient and purpose.

Cultural competence stages: awareness of one's own biases, knowledge of other cultures, skill in cross-cultural interaction, and ongoing attunement.

Health disparities are measured by differences in incidence, prevalence, mortality, and burden of disease across groups.

Title VI of the Civil Rights Act requires language access services for federally funded programs, including interpreters.

Use qualified medical interpreters, not family members, for clinical communication; document interpreter use.

Cultural humility emphasizes lifelong self-reflection and recognizing power imbalances rather than mastering a fixed body of knowledge.

Explanatory models elicit the client's beliefs about cause, course, and treatment of illness.

Social determinants of health include income, education, housing, food security, transportation, and neighborhood conditions.

Spiritual and religious beliefs may affect diet, medication adherence, end-of-life decisions, and treatment preferences.

SBAR handoff format: Situation, Background, Assessment, Recommendation.

Active listening techniques include paraphrasing, reflecting feeling, clarifying, and summarizing.

Documentation standards: objective, accurate, timely, complete, legible, and free of speculation or opinion.

Late entries must be labeled as late with the date/time of entry and reason; never alter or backdate a prior note.

Protected health information includes names, dates, identifiers, and any data that could identify the client.

Minimum necessary standard limits access to PHI to what is needed for the purpose.

Teach-back confirms client understanding by asking the client to explain information in their own words.

Conflict resolution uses 'I' statements, focuses on interests not positions, and separates the person from the problem.

Continuing education requirements are set by state licensing boards and certifying bodies; verify current hour requirements locally.

Professional certification typically requires exam passage, documented experience, and periodic recertification.

Advocacy levels: client-level (individual), system-level (organization/policy), and legislative-level (law).

Self-care and burnout prevention address compassion fatigue, vicarious trauma, and boundary maintenance.

Supervision and consultation are used when a case exceeds competence or involves ethical uncertainty.

Professional codes of conduct are enforced by licensing boards and certification bodies, with sanctions ranging from reprimand to revocation.

Quality improvement uses plan-do-study-act cycles and measurable indicators to improve outcomes.

Interprofessional collaboration requires defined roles, shared goals, and mutual respect across disciplines.