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What is “Case Management” (and what is it not?)

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at November 7, 2016

The concept of “case management” for drug and alcohol treatment patients has recently become the focus of attention by law enforcement as the term has been abused to be a synonym of patient brokering. Which is a shame considering we constantly need to change our terms of use in order to communicate ethical behavior from unacceptable behavior.

In Florida, the concept of “case management” is part of the “system of care” which are a coordinated continuum of community-based services and supports that are organized to meet the challenges and needs of individuals who are at risk of developing substance abuse problems or individuals who have substance abuse problems.

Similar to when “Obamacare” was rolled out and there were “Navigators” used to help people sign up for insurance, it appears that we need unbiased, ethical Navigators simply to get a patient from addiction to initial abstinence (Healthcare.gov defines “Navigator” to mean “An individual or organization that’s trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms. These individuals and organizations are required to be unbiased. Their services are free to consumers.”).

From there, we need “Case Managers” to oversee the ongoing treatment of patients to avoid relapse, and then ultimately, “Recovery Coaches” to ensure long-term sobriety. [See “States See Peer-Recovery Coaches As A Way To Break The Addiction Epidemic http://khn.org/news/states-see-peer-recovery-coaches-as-a-way-to-break-the-addiction-epidemic/].

This all sounds so utopian, as insurance will not pay for these services (at least, not until there is definitive evidence that relapse is avoided by doing so, and that such professionals cost less than Suboxone).

According to local attorney Myles Schlam, JD, CAP/CCJAP and his writing “The Role of Case Management in Substance Abuse Treatment” (Sober World, Vol. 2, Issue 10, Nov. 2013):

Case Management is one of the most overlooked and underestimated components of clinical Addiction treatment. Many people are not aware that in the State of Florida, an agency must be licensed by the State in order to provide Case Management services. An agency licensed for Case Management is held to all the same licensure requirements as any addiction treatment facility.

The concept of “Case Management” falls with the larger term of “Intervention” and is addressed, at least in Florida, under Rule 65D-30.012 of the Florida Administrative Code.

While we agree with Mr. Schlam, generally, we note that the rule provides for licensed Case Managers appear to apply only “in those instances where case management is provided as a licensable sub-component of intervention.”

Does “Case Management” need to be provided as part of Intervention?  According to the rule, “only in those instances” where it is “provided as a licensable sub-component of intervention”.

What does this actually mean? Will private pay insurance cover “Case Management” if provided by a licensed Interventionist?

Ironically, perhaps, there are four requirements of case management:

  1. On-going assessment and monitoring of the client’s condition and progress;
  1. Linking and brokering for services as dictated by client needs;
  1. Follow-up on all referrals for other services; and
  1. Advocacy on behalf of clients.

“Brokering for services”??

While we do not know what was meant by the agency responsible for crafting these rules (in Florida, the Department of Children and Families), we find it at least interesting of the use of the term “brokering”.

Which triggers the larger question – what is the ethical, moral, rightful, and legal intersection between “Interventionists”, “Case Managers”, and “Marketers”?

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