OPM: Partnership Consumer Case Management

Care Management

(also known as Care Coordination, Case Management, or Care Advisory Services) for Connecticut Partnership for Long-Term Care Plans

Question:
What is Care Management?

Answer:
Care Management is a service for you and your family that identifies, links, coordinates and monitors assistance from formal service providers such as home health aides, and informal caregivers such as family and friends, to help you remain at home safely and achieve the highest level of independence.

Question:
Is the purpose of Care Management to limit or restrict the home care services a Partnership policyholder can receive?

Answer:
Absolutely NOT. In fact, just the opposite is true.

The role of the Care Manager includes assessing your needs, assisting you with planning and coordinating your care and then monitoring and reassessing your needs over time. Care Management is NOT managed health care. Care Management is a resource and benefit that can help you and your family better manage your care at home.

Question:
Why are Care Management benefits required to be part of my Connecticut Partnership policy’s home care benefit?

Answer:
Partnership policies are designed to include the highest level of consumer protection and benefits. A comprehensive Care Management benefit can help you remain in your own home and be as independent as possible. Care Managers can coordinate and monitor the services provided. They can also benefit you financially since, in some cases, they can help arrange for discounts on the services you receive and can help maximize your resources.

Question:
Who provides the Care Management services included in my Connecticut Partnership policy?

Answer:
The Connecticut Partnership requires that only approved "Access Agencies" provide the Care Management services included in your Partnership policy. Each insurance company participating in the Partnership contracts with one or more of the approved Access Agencies to provide Care Management services.

Access Agencies must meet certain regulatory requirements such as assuring that their Care Managers meet State-required training and education criteria. These criteria require Care Managers to have expertise in developing Plans of Care, which provide a comprehensive measure of need and the services to meet those needs. Care Managers employed by Access Agencies also are familiar with various home care and community options. Care Managers generally are nurses and social workers. In addition, and of importance, Access Agencies are not allowed to provide home care services to you, other than Care Management benefits. Since one of the roles of the Access Agency is to monitor the provision of home care services, it would be a conflict of interest to monitor itself.  

See the approved list of Access Agencies.

Question:
What services are provided with the Care Management benefit under a Connecticut Partnership policy?

Answer:
A Care Manager from an approved Access Agency does an initial assessment, which includes a face-to-face visit with you, your family and other caregivers. If your insurance company determines you are eligible for benefits, the Care Manager develops a comprehensive Plan of Care identifying all the services and supports you will need to stay at home safely.

Care Managers also do periodic reassessments to see if your needs have changed. If you desire, the Care Manager can also help coordinate the services you need and monitor the services provided.

When a Connecticut Partnership policyholder files a claim for home care services, regardless of where he or she is receiving the services, the insurance company will arrange for an Access Agency’s Care Manager to provide the Care Management benefits.

Question:
Will a Care Manager work with your doctor?

Answer:
Absolutely. If you give your permission, the Care Manager will work with any health care professional involved in your care to develop a Plan of Care to meet your needs.

In developing a Plan of Care, the Care Manager must obtain a comprehensive picture of what your needs are, and therefore, communicates with other health care professionals, family members and any others who are involved in your care.

Question:
Does the Care Manager determine whether you are eligible for benefits under your insurance policy?

Answer:
No. The insurance company makes all eligibility determinations. The Care Manager provides information, through its assessment, that can help the insurance company make its determination, but the decision is not made by the Care Manager or Access Agency.

Question:
What is a Plan of Care? How is it used?

Answer:
One of the most important roles of the Care Manager is to develop a Plan of Care. A Plan of Care is an individualized plan that you, your family and Care Manager develop together, based on your needs, preferences and values. The Plan of Care should include all the services you need to remain safely in your home, including services requested by your physician.

The care planning process begins with the face-to-face needs assessment and continues throughout your receipt of home care benefits. The Care Manager works with you and your family members to determine how the needed services will be provided and paid for. This assistance is important because you may need services that are not covered by your long-term care insurance policy. All services, whether covered by your policy or not, must be included in the written Plan of Care, along with a list of possible service providers and costs. Only those services included in your Plan of Care will be considered for reimbursement by your long-term care insurance policy.

Question:
Who pays for the Care Management services?

Answer:
Care Management services are covered by every Connecticut Partnership policy. The cost of the initial assessment and development of a Plan of Care, if necessary, is always paid by the insurance company and does not reduce the lifetime benefit under your policy. Depending on the particular insurance company, payment for other Care Management benefits such as coordination and monitoring services, may reduce your lifetime benefit amount. (See the Partnership’s "Policy Comparisons" report to learn how the different companies pay for Care Management services). The amount of coverage for Care Management services varies between companies.

Question:
Can the Care Manager assist me while I’m still in my Elimination Period (Deductible) and haven’t yet received benefits under my policy?

Answer:
Yes. Unlike most other long-term care services covered under your Policy, Care Management benefits do not require that you first meet your Elimination Period or Deductible. The Care Manager can develop your Plan of Care and work with you to secure the necessary services even before your insurance policy begins to pay benefits.

Question:
Do I need a Care Manager to enter a nursing facility?

Answer:
No, generally patients are admitted to a nursing facility by their doctors.

A Care Manager who has been providing services to you in your home may be able to help smooth your transition to a nursing facility by communicating your needs to the facility’s staff. If you wish, the Care Manager can help you and your family with the transition. Such assistance would be covered under the Care Management benefit in your policy.

For more information see the list of Access Agencies approved for participation in the Connecticut Partnership for Long-Term Care. 

 

 

For more information contact:
David Guttchen, Director
David.Guttchen@ct.gov
(860) 418-6318


 





Content Last Modified on 11/30/2009 1:50:55 PM