ACA CCM flashcards
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34 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Case Management Process Steps
- Intake and screening, assessment, problem identification, care planning, implementation, monitoring, evaluation, and closure or transition, generally applied in that order.
- Case Management Definition
- A collaborative process assessing, planning, implementing, coordinating, monitoring, and evaluating options and services to meet a client's health needs.
- Care Plan Goals
- Goals must be measurable, time-bound, client-centered, and linked to specific interventions with assigned responsibility for each action.
- Transition Planning Timing
- Discharge and transition planning begins at intake so that post-service needs, resources, and referrals are arranged before services end.
- Case Closure Criteria
- Closure occurs when goals are met, the client no longer needs services, the client withdraws, or coverage ends, and is documented with a summary.
- Maslow's Hierarchy
- Needs ordered from physiological, safety, belonging, esteem, to self-actualization; lower-level needs generally take priority until reasonably met.
- Stages of Change
- Precontemplation, contemplation, preparation, action, maintenance, and relapse; relapse is a normal stage in the cycle rather than failure.
- Motivational Interviewing
- A directive, client-centered counseling style using open questions, affirmations, reflections, and summaries to strengthen the client's own motivation.
- PHQ-9 Purpose
- A nine-item screening tool that measures depression severity and can track response to treatment over time.
- Suicide Risk Assessment
- Evaluation of ideation, plan, intent, access to means, prior attempts, and protective factors to determine level of intervention needed.
- Medicare Part A
- Hospital insurance covering inpatient hospital stays, skilled nursing facility care after a qualifying stay, hospice, and some home health.
- Medicare Part B
- Medical insurance covering physician services, outpatient care, durable medical equipment, and preventive services, subject to premiums.
- Medicaid Funding
- A joint federal-state program administered by states, with eligibility and covered benefits varying by state within federal requirements.
- Prior Authorization
- A utilization management requirement that the payer approve a service before it is delivered for coverage to apply.
- HIPAA Treatment Payment Operations
- Permits disclosure of protected health information without authorization for treatment, payment, and healthcare operations purposes.
- Functional Independence Measure
- A standardized tool scoring independence in motor and cognitive activities of daily living to track rehabilitation progress.
- HCBS Waiver
- A Medicaid program that funds home and community-based services so eligible people can live outside institutional settings.
- ADA Reasonable Accommodation
- An adjustment to a job or program enabling a qualified person with a disability to participate, unless it causes undue hardship.
- Referral Verification
- Confirming a resource's eligibility criteria, availability, cost, and location, and obtaining client consent before sharing information.
- Informed Consent Elements
- Client capacity, disclosure of risks and benefits, understanding of information, and voluntary agreement without coercion.
- Mandatory Reporting
- Legal duty to report suspected child abuse, elder abuse, or dependent adult abuse to the designated agency, overriding confidentiality.
- Ethical Principles
- Autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity guide professional decisions when duties conflict.
- Advance Directive
- A written statement such as a living will or healthcare power of attorney expressing treatment preferences if the person loses capacity.
- Dual Relationship Risk
- A second relationship with a client, such as business or social, that may impair judgment or exploit the client's trust.
- Title VI Language Access
- Requires federally funded programs to provide meaningful access to limited-English-proficient individuals, typically through qualified interpreters.
- Qualified Interpreter Use
- Clinical communication should use trained medical interpreters rather than family members or children, with interpreter use documented.
- Cultural Humility
- An ongoing process of self-reflection and openness to the client's cultural identity, recognizing power imbalances rather than claiming mastery.
- Social Determinants
- Conditions such as income, housing, education, food security, and transportation that shape health outcomes and access to care.
- SBAR Handoff
- A structured communication format covering Situation, Background, Assessment, and Recommendation to convey clinical information concisely.
- Late Entry Documentation
- A note added after the fact must be labeled late and include the actual entry date, time, and reason, without altering earlier records.
- Minimum Necessary Standard
- Requires limiting use or disclosure of protected health information to the least amount needed to accomplish the purpose.
- Teach-Back Method
- Asking the client to restate information in their own words to confirm understanding and correct misunderstandings.
- Scope of Practice
- The range of duties a professional may legally perform, defined by state licensure law and further limited by employer policy.
- Advocacy Levels
- Client-level advocacy for an individual, system-level advocacy within organizations, and legislative advocacy for policy change.