This course is designed to assist care givers or coordinators in managing chronic behavioral and physical conditions of Medicaid beneficiaries. The Centers for Medicare and Medicaid Services (CMS) encourages states to utilize long term supports and services (LTSS) in the community over institutional settings. As such, the field is currently experiencing a push toward beneficiaries remaining in their homes for as long as possible and expanding Medicaid services to match the initiative.
Section 1: Introduction
A. About This Course
B. Learning Objectives
Section 2: A Primer on Medicaid Service Delivery Systems
A. Medicaid, Eligibility, and Funding
B. Supplemental Community Services
Section 3: Improving Care Transitions
A. Implementing the Care Plan
B. Managed Medicaid Benefits
C. Discharge Planning
D. Beyond Discharge Planning
E. Managing Beneficiaries with Behavioral Conditions
F. Community Resources
G. Applying Your Knowledge
Section 4: Chronic Care Management
A. Identifying and Managing Chronic Conditions
B. Care Pathways
C. Patient-Centered Care Planning
D. Developing a Plan
Section 5: Conclusion
B. Course Contributor
Maureen McCarthy is the President of Celtic Consulting, LLC and the CEO and founder of Care Transitions, LLP, a post-discharge care coordination service provider. Maureen is also the creator of the MCCARTHY METHOD, a documentation improvement system for ADL coding. She has been a registered nurse for 30 years with experience as an MDS Coordinator, director of nursing, rehab director, and a Medicare biller. A recognized leader and expert in clinical reimbursement in the skilled nursing facility environment, Maureen is currently the president for the Association of Long Term Care Financial Managers, is the Medicare Advisor for Connecticut Association of Health Care Facilities (CAHCF), is an advisor to the J-13 Medicare contractor National Government Services Provider Advisory Group, and is a member of the AANAC Expert Advisory Panel. She is also an Editorial Advisor for HCPro, a national publication for post-acute care providers, as well as an advisor to the New York State Health Facilities Association on the Nursing Leadership Committee and the Payment for Services Group. Maureen is dually certified in both the resident assessment process and quality assurance performance improvement process by nationally recognized organizations and holds Master Teacher status with AANAC and AADNS. She holds a degree in Business Management as well as a Nursing degree and served as an expert witness. In September of 2011, she released her first co-authored publication, The Long Term Care Compliance Toolkit. Her other publications include ICD-10 Compliance Process Improvement and Maintenance for LTC (June 2015), Medicare Audits: A Survival Guide for SNF (October 2016), and Using the 5-Star Technical Users Guide (March 2017). Maureen is currently planning a fifth publication in 2017 on Medication Reconciliation. Disclosure: Maureen McCarthy has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
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