Case Management Ethics
Case Management Toolbox

 
 
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Case Management and Counseling Ethics and Scope of Practice
Case Management Toolbox Podcast
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director: AllCEUs Continuing Education
Host: Counselor Toolbox Podcast & Case Management Toolbox Podcast
Objectives
~ Explain the scope of practice and code of ethics for case managers
~ Compare and contrast the code of ethics and scope of practice for case managers to that of Rehabilitation and Mental Health Counselors and Social Workers

Scope of Practice
~ CM ensure that the treatment team has provided education about the injury/disease/condition
~ CM provides information to the team and the client and family regarding available resources and benefits
~ Identify clinical, psychosocial, financial, operational and/or environmental issues which may need to be addressed to ensure quality care and reimbursement
~ CM will use assessment complimentary tools that identify risks associated with client needs
~ CM and client will develop a plan of care that matches the patients needs, preferences and available resources
~ CM will help sequence and organize the implementation of services to ensure efficient, effective care delivery
Scope of Practice
~ CM documentation focuses on acquisition and utilization of resources as they pertain to reducing risk and enhancing treatment delivery.
~ Risks include
~ Early termination/sporadic participation
~ Ineffective treatment (i.e. for someone who is hearing impaired or has limited literacy)
~ Worsening of symptoms due to medication noncompliance
~ Additional complications due to difficulty with ADLs
~ Readmission

Scope of Practice
~ CM and Counselors will identify available community resources and advocate for the resolution of gaps in services and/or problems in process implementation
~ CM and Counselors ensure all elements of the transition plan are communicated to all stakeholders as appropriate.
~ CM and Counselors will track avoidable delays and identify and communicate opportunities for improvement
~ CM and Counselors will proactively prevent denials based on medical necessity by documenting relevant information and educating key stakeholders
Ethical Principles of Counseling and CM
~ Beneficence
~ Act in the best interest of the client. Includes advocacy.
~ Nonmalfesance
~ Do no harm
~ Fidelity
~ Be faithful to your word
~ Justice
~ Ensure clients receive equal and fair treatment
~ Autonomy
~ Empower clients for success

Public Interest
~ Place the public interest above your own at all times (B, N, J)
~ False billing leads to higher insurance rates and loss of trust in the profession
~ Continuing to work while “burned out” or psychologically unavailable can harm clients and negatively impact perception of the profession
~ Report/address known misconduct
~ Make referrals when other providers are more appropriate due to case content or caseload
~ As a client advocate identify options and provide choices
Respect Rights and Inherent Dignity
~ Respect Rights and Inherent Dignity of All Clients (B, N, J, A)
~ Do not make decisions for clients which they can make for themselves
~ Advocate for client empowerment and autonomy
~ Respect the cultural values and personal preferences of clients
~ Inform clients about confidentiality restrictions

Maintain Objectivity
~ Maintain Objectivity with Clients
~ Is able to clearly articulate reasoning behind recommendations
~ Avoids making referrals to “preferred” vendors
~ Respects their cultural values and perspectives
~ Does not impose their own values or perspectives
~ Is aware of and addresses any transference or countertransference issues
~ Regularly self-evaluates performance
~ Avoids any dual relationships
Dual Relationships
~ Can exist between the case manager or counselor and
~ Client
~ Payor (insurance, state contract)
~ Employer (of the professional or client)
~ Friend/Relative (of the professional or client)
~ Other entities
Act with Integrity and Fidelity
~ Act with Integrity and Fidelity with Clients and Stakeholders
~ Recognize and demonstrate joint accountability
~ Contributes to decision making
~ Do not promise things you cannot deliver
~ Do not bend the rules
~ Do what you say when you say you will do it
~ Comply with directives from the Ethics Committee
~ Do not accept or provide kickbacks or “gifts” for referrals
~ Ensure clients are provided a warm referral for all necessary services
~ Ensure clients are fully informed about the costs, benefits and risks of all services
~ Advertise services accurately
~ Complete documentation in an accurate and timely manner
~ Ensure all clients are providing informed consent
Maintain Competency
~ Maintain Competency to Provide the Highest Level of Service
~ Take care of your own health and mental health
~ Seek additional training if working with a new population
~ Regularly seek out continuing education, collaboration and consultation to enhance your ability to provide effective services with your population
~ Maintain awareness of all changes in regulations including ADA, HIPAA, reimbursement (i.e. capitation and reimbursable services)
~ Maintain all case notes as required by regulations (i.e. HIPAA) and laws (i.e. 7 years)
Honor the Integrity of the Certification/License
~ Honor the Integrity of the Certification/License
~ You represent the entire profession in your interactions with clients, stakeholders and the public.
~ Practice within your bounds of competence (even if that is more narrow than your legal scope of practice)

Obey All Laws and Regulations
~ Obey All Laws and Regulations
~ Americans with Disabilities Act
~ HIPAA
~ HITECH
~ Reimbursement
~ Scope of practice
~ Mandatory reporting
~ Good citizen laws

Provide Input to Review and Revise the Code
~ Provide Input to Review and Revise the Code
~ Ex. Adding a section for ethical considerations when providing virtual services
~ Ex. Advocating for the ability for people with substantial recovery from substance use who have a felony on their record to be able to provide services after a given period of time
Values
~ Believe that case management (counseling) is a means for improving the health, wellness and autonomy of the individual through
~ Advocacy
~ Communication with the patient, family, stakeholders
~ Education of the patient, family, stakeholders and community
~ Identification of service resources
~ And facilitating remediation of gaps (ROSC)
~ Service facilitation (CM)
Values
~ Recognize the dignity and worth of all people and strive to help them be the best version of themselves that they can be (as they define it)
~ Socioeconomic status
~ Health conditions
~ Mental health conditions (cognitive and emotional)
~ Culture
~ Religion
~ Race
~ Sexual orientation
~ Sexual/relationship preferences
~ Appearance

Values
~ Commit to quality outcomes, appropriate use of resources and empowerment of the individual
~ Evidence based practices
~ Do not over-refer or change diagnostic codes to enhance billable hours
~ Use scaffolding to assist clients in achieving outcomes
Values
~ Embrace the premise that when individuals reach the optimum level of functioning the client, stakeholders (healthcare delivery and insurance reimbursement systems) and the community all benefit
~ Financially
~ Occupationally
~ Interpersonally
~ Legally

Summary
~ Both counselors and case managers are bound by the principles of beneficence, nonmalfeasance, autonomy, justice and fidelity.
~ Whereas counselors focus on the diagnosis and treatment of mental health issues, case managers assess client needs and facilitate access to services and resources necessary to achieve the highest quality of life (as defined by the client)