By Jeanie Davis

Legislation and regulatory changes do not always seem in patients’ best interests. Insurance coverage issues have made news headlines. In skilled nursing facilities, physical therapy time has been limited by the Centers for Medicare & Medicaid Services (CMS), which has also triggered concerns.

What can a case manager do? When one sees changes of concern, what is one's recourse? How can one influence state legislators/regulators, and public policy?

Advocacy for patients is integral to the case manager’s role, explains MaryBeth Kurland, CEO of the Commission for Case Manager Certification (CCMC). “Case managers are always looking at areas or protections related to how they practice that impact how they serve clients. They inherently ask, ‘Is this change important? Will it affect the client?’”

As a credentialing body, CCMC works to ensure consumer protection and make sure the client is safe, she adds. The organization considers whether every new regulation or law will benefit the client. They also assess if the change will protect the role of the case manager in ensuring public protection. CCMC partners with Case Management Society of America (CMSA) and National Association of Social Workers (NASW) to support their advocacy efforts.

CCMC also has joined the Professional Certification Coalition, a group that monitors state legislation. That group has advocated for a bill that would allow individuals to use 529 plans (typically used for college education) to pay for certification. The House passed that bill; Kurland is hopeful the Senate will pass it as well.

What Case Managers Can Do

Kurland advises case managers to:

• Stay current and monitor legislation related to healthcare issues, on both the federal and state levels. “Very often, these issues are directly related to what case managers do,” she says.

• Discuss the issue with their professional association’s local chapter. If one person is concerned, his or her colleagues are, too.

• Be active in local chapters of professional organizations like NASW and CMSA that support the case manager community. “A lot of information about what is happening at the state level gets shared at the grassroots level,” says Kurland. “Involvement in these groups will help keep you current on those state issues.”

CCMC’s executive team attends NASW and CMSA state and regional meetings, as well as regional meetings hosted by American Case Management Society (ACMA). “We also are an ANCC provider for accredited education,” says Kurland. “Nursing is our base, but we are diversifying as a community to include more social workers and other professionals doing case management.”

Advocacy efforts can bring results, as with the Nurse Licensure Compact, an agreement between states that allows nurses to have one license with the ability to practice in other states that are part of the agreement. “This offers nurses many more opportunities for employment, including telehealth,” Kurland says.

She also encourages case managers to look for mentoring opportunities, or to seek a mentor. “Having that relationship can help you stay current and better understand what’s going on in the legal or regulatory landscape,” she says.

Case managers also should share their stories, adds Kurland. “If you see something going on and you are concerned how it will impact you as a case manager or your clients, send a letter to lawmakers. Tell them what’s going on in the front lines.”

Be vocal, whether through social media, through letters, or contacting congressmen or senators. If a case manager sees a connection with another professional association, contact their home office.

“Provide feedback after a law or regulation gets passed,” Kurland adds. “You can still go back to your elected officials — whether it is helping, what can be improved. Your local groups are a good channel to communicate. The intent of the law may not be how it is actually being practiced.”

“Patient advocacy is an important component of the work of an RN or social work case manager,” says Toni Cesta, PhD, RN, FAAN, partner and consultant with Case Management Concepts, LLC. “It is included in the guiding principles for case management in the CMSA Standards of Practice. In fact, advocacy is one of the six key functions that case managers perform. These include assessment, planning, implementation, coordination, advocacy, and evaluation.”

Advocacy takes many forms for case management professionals, she explains. “As such, one of our responsibilities is to stay current with issues associated with the CMS Conditions of Participation and other regulatory requirements related to case management.”

The CMS Conditions of Participation for Discharge Planning and Utilization Review apply directly to case management work, and are sometimes changed by CMS, Cesta adds.

Check CMS’s blogs and updates regularly. “In this way, you can learn what is changing or being considered for change," she says. "CMS generally provides a ‘comment period’ before anything becomes law. That’s another opportunity to voice your concerns.”

Maintain membership in your associations. “When you don’t agree with an actual or proposed change, you can make your voice heard through one of your national organizations,” says Cesta. Both CMSA and ACMA have working committees that focus on political issues of concern, and even attend meetings in Washington, DC.

“By bringing your issue to them, they can work on your behalf to address these issues directly with legislators and others,” she explains. “This type of lobbying work can be very successful. Changes in legislation related to observation status came directly from this type of work.”

Even lay organizations advocate for patients. AARP was actively involved in the issues associated with observation status. “Add your voice to the mix when you feel that something isn’t in the best interests of our patients, and make a difference,” says Cesta.