HD98 - Case Management System Development Activities

  • Published: 1994
  • Author: Secretary of Health and Human Resources
  • Enabling Authority: House Joint Resolution 564 (Regular Session, 1993)

Executive Summary:
As a result of the work of the 1992 Case Management Task Force and human services agencies reporting in this Response to House Joint Resolution 564, significant steps have been taken toward enhancing case management services in the Commonwealth of Virginia. Design and implementation of service delivery models that integrate technology, confidentiality forms, single assessment, etc., will move the Commonwealth further toward a comprehensive, consumer-responsive approach to case management.

House Joint Resolution 564 (HJR 564), agreed to by the 1993 Session of the General Assembly, requested the Secretary of Health and Human Resources to develop a consumer-responsive case management system to strengthen coordination of services, consumer choice, accountability of service providers, and cost-effectiveness of service provision. It was resolved by the House of Delegates, the Senate concurring, That the Secretary of Health and Human Resources be requested to direct the following:

1. That the state human agencies serving persons with physical and sensory disabilities adopt an interagency policy that allows consumers to designate the primary reimbursed case manager when the consumer is receiving services from more than one health and human service agency;

2. That the Department for Rights of Virginians with Disabilities conduct a feasibility study of maintaining and incorporating results from consumer satisfaction surveys to promote quality assurance in case management services within both the public and private sectors. This study shall also determine the need of establishing a central listing of complaints regarding the quality of services provided by case managers in both the public and private sectors. Consumers and providers of case management services, both public and private, shall be included in all phases of the study;

3. That the Department of Rehabilitative Services explore the feasibility of contracting with Centers for Independent Living as a way to increase accessibility to case management services; and

4. That all state human service agencies serving persons with physical a sensory disabilities and providing case management services conduct an analysis of the most cost-effective manner of the delivery of those services. This study shall compare the cost of providing case management services utilizing agency staff with that of contractual services.

This report responds to the requirements of HJR 564 with contributions from the state human services agencies serving persons with disabilities. There are four parts to this report, one for each of the tour parts of the resolution.

PART 1: Interagency Policy On Consumer Designation of Primary Reimbursed Case Manager

Part I of HJR 564 requested that "the state human services agencies serving persons with physical and sensory disabilities adopt an interagency policy that allows consumers to designate the primary reimbursed case manager when the consumer is receiving services from more than one health and human service agency.

The Department of Rehabilitative Services facilitated a work group that included representation from state human service agencies, advocacy organizations and persons with physical disabilities. The work group developed an interagency agreement, the Memorandum of Understanding, Consumer Choice for Primary Reimbursed Case Manager (Appendix B).

The Memorandum of Understanding has been transmitted to the Secretary of Health and Human Resources. The next steps for the agreement include review from the Secretary and heads of participating agencies for signature. Once all parties have signed it, the Memorandum of Understanding will take effect.

PART 2: Consumer Satisfaction

Part 2 of HJR 564 requested that "the Department for Rights of Virginians with Disabilities conduct a feasibility study of maintaining and incorporating results from consumer satisfaction surveys to promote quality assurance in case management services within both the public and private sectors...[and] determine the need of establishing a central listing of complaints regarding the quality of services provided by case managers and their organizations in both the public and private sectors." Part 2 also requested that "consumers and providers of case management services, both public and private, shall be included in all phases of the study."

The Department for Rights of Virginians with Disabilities facilitated a Study Team composed of representatives from state agencies, private case managers, and consumers, which convened twice and came to a consensus on their report.
Conclusions

• State agencies are currently conducting consumer satisfaction surveys and utilizing the information to improve case management services.

• Private case management providers assure quality in case management through established industry standards and practices.

• It is more beneficial to encourage agency systems to continue to be consumer-responsive than to develop an additional process removed from the source of the problem.

• Establishing a central listing of complaints would create a new and unnecessary bureaucracy.

• Establishing a central listing would be of very limited usefulness in ensuring quality in case management.

Recommendations

1. State agencies which provide case management shall continue to conduct consumer satisfaction surveys and use the findings to promote quality assurance in case management.

2. Private providers of case management shall continue to maintain industry standards to promote quality assurance in case management.

3. A central listing of consumer complaints should not be established.

PART 3: Feasibility of Contracting for Case Management Services

Part 3 of HJR 564 requested "the Department of Rehabilitative Services explore the feasibility of contracting with Centers for Independent Living as a way to increase accessibility to case management services."

The Long-Term Rehabilitation Case Management (LTRCM) Program of the Department of Rehabilitative Services (DRS) is the first phase of service system development for people with severe neurological disabilities. In evaluating the feasibility of contracting with Centers for Independent Living (CILS) for provision of case management, it is important to note that providing case management services to individuals is just one part of the broader system development mandate of the LTRCM Program, and that it is not possible to distinguish between the two in a manner which would be statistically or actuarially meaningful.

Conclusions

DRS determined that, although both LTRCM and CILs assist consumers to develop goals, establish plans to achieve those goals, facilitate or coordinate services, and concern themselves with consumer advocacy and empowerment, it is not feasible to contract case management services under current conditions. Nevertheless, DRS will continue to involve stakeholders in defining an overall system of service delivery for persons with severe functional and central nervous system disabilities. As an overall system of rehabilitative and support services is designed and implemented, there may be opportunities for contractual or fee-for-service relationships with CILs and other service providers. A comprehensive system will require additional funding and it may address differing levels of case management based on consumer need and on an array of service approaches that supplement or complement the highly specialized and centrally managed LTRCM Program. The selection of service providers within the overall framework will relate to the individual provider's capacity to meet client needs and assure system wide consistency and quality.

Recommendations

1. It is recommended that DRS, through the LTRCM Program, complete the first phase of systems development for coordination of services f6rpersons with functional and central nervous system disabilities.

2. Regardless of strategies which may evolve for an overall system of services, it is recommended that DRS continue the provision and expansion of the highly specialized case management services currently available through its LTRCM Program. Clients with these most severe functional and central nervous system disabilities require an intensity of case management which is best provided through a program and staff with focused specialization, training, and expertise.

3. DRS should continue to involve stakeholders in defining an overall system of service delivery for persons with severe functional and central nervous system disabilities. Over time, this may include other aspects of case management or complement LTRC . Service a framework that ensures quality and

PART 4: Cost-Effectiveness of Service Delivery

Part 4 of HJR 564 requested that "all state human service agencies serving persons with physical and sensory disabilities and providing case management services conduct an analysis of the most cost-effective manner of the delivery of those services...[comparing] the cost of providing case management services utilizing agency staff with that of contractual services."

To address the intent of the resolution, each agency conducted its own review based on individualized evaluation methods and data collection.

Conclusions

Ideally, a least-cost analysis is an appropriate method to study the cost-effectiveness of case management service delivery. This approach identifies the least costly method to attain a pre-established, measurable level of an objective, by analyzing each of several alternative methods of achieving that level in terms of dollar expenditures needed to do so.

In the present situation, however, the multifaceted nature of case management services generally cannot be reduced to a single objective and, where multiple explicit objectives exist, costs cannot be meaningfully distributed to individual objectives. Reflecting its statutory definition (Section 51.5-3), case management incorporates diverse components such as advocacy, assessment, planning, facilitation, coordination and monitoring to create a dynamic collaborative process which utilizes and builds on the strengths and resources of consumers to assist them in identifying their needs, accessing and coordinating services, and achieving their goals. Statistical or actuarial efforts to isolate specific costs associated with a specific service component, be it that of a state agency or a contractual provider, become artificial, calling into question the validity of any comparative analysis.