Agencies | Governor
Virginia Regulatory Town Hall
Agency
Department of Medical Assistance Services
Board
Board of Medical Assistance Services
chapter
Amount, Duration, and Scope of Medical and Remedial Care and Services [12 VAC 30 ‑ 50]
Action 2011 Mental Health Services Program Changes for Appropriate Utilization & Provider Qualifications
Stage Final
Comment Period Ends 1/29/2015
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1/29/15  11:05 am
Commenter: Chris James, MSW, VCUHS

In-Home regulation changes
 

My objections to the removal of case management and addition of the term "care coordination" proposed to the DMAS regulations have already been brilliantly articulated by other commentators in this forum. I would like to place my support behind the statements of Andrew Slabaugh and Kathy Levenston.

The greatest challenge I perceive in the removal of "case management services" from in-home workers, other than those which have already been stated, is that very often the tasks performed through case management are the same tasks which require the therapeutic intervention targeted by the in-home intervention in the first place. By requiring an in-home worker to delegate these responsibilities to another provider, it necessarily slows and complicates treatment as well as reducing the effectiveness of the in-home therapy overall. Instead of using these opportunities to improve the overall family dynamic and function, the in-home worker would need to prepare the family to engage in these activities, then await a report from the case manager and the family on how the family performed. It would be far more efficient for the in-home worker to be present for these interactions and to be able to utilize these activities as both real-life training and coaching opportunities (as is currently done) and as real-time assessment techniques instead of relying on client self-report. Further, there is substantial literature to support the importance of rapport as a predictor of treatment success. By delegating these valuable interventional tasks to  a third-party, the rapport developed by the in-home worker (a primary benefit of the service) is lost. 

Finally, if the intention behind this change is financial, I am afraid that any gain made by shifting the workload to case-management providers will be offset by a reduction in effectiveness of the overall treatment and an increase in time spent working to resolve the presenting issues. This benefits neither the taxpayers nor the clients.

CommentID: 37833