Athena Forum Collaborates with CMSA in Online Educational Forum for Case Managers

Athena Forum.com, an educational service of Business Media Associates, Inc., has joined with the Case Management Society of America (CMSA) to make available the newly developed web-based educational forum for case managers working in managed care settings.

Representing a new brand of text-based clinical education available on the Internet, Athena Forum.com will soon have more than 3,000 pages of accredited CE education with curriculum specifically designed using recent needs assessment research collected from a variety of 400 RN case managers nationwide. All CCM certificates are subsequently awarded by the Commission for Case Manager Certification (CCMC).

Athena Forum's course curriculum displays a growing number of 200-page courses on: asthma, behavioral health, breast cancer, CAD, CHF, COPD, diabetes, MS, women's health, obesity management, pain management, RA and more. Each permanent, searchable, state-of-the-art course is supervised by a clinical expert course director and updated quarterly. Available to healthcare employers for $125 per year per participant, the password-protected subscription service is offered to clinicians and is not available to patients or consumers. All CE certificates are included and can be stored on the Athena Forum site or printed. As a benefit to CMSA members, a special inclusive price of $95 includes all courses for an entire year, a strong incentive for its members to take all the courses.

To access Athena Forum from the CMSA website, go to: http://www.cmsa.org/Education/. For more information, contact Thomas A. Rasmussen, President, Business Media Associates, Inc., and Publisher of Athena Forum.com at 301-279-2160 or by email at trasmussen@biz-media.com.

URAC State UM Survey Finds Significant Regulatory Increases, Law Changes Since 2000

Ninety percent of all states now regulate either health utilization management (UM) entities and/or UM activities by managed care organizations, an increase of 12 percent since 2000, according to the results of a URAC survey of state UM laws and regulations. URAC completed an extensive survey of UM laws and regulations in all 50 states and the District of Columbia this past summer. Other highlights of this survey show that:

• 34 states require licensure, registration, certification, or accreditation for health UMOs, or organizations that practice UM (up 13 percent since 2000)
• 39 states have specific clinical review criteria guidelines for UM or managed care entities (up 11 percent since 2000)
• 24 states impose prohibitions on financial incentives for UM reviewers or UM organizations (up 9 percent since 2000)
• 36 states require UM or managed care entities that practice UM to make any clinical review criteria used for adverse determinations available upon a participant's request (up 89 percent since 2000)
• Rights legislation now require some sort of initial appeals process for UM activities (up 25 percent since 2000) and 39 states and the District of Columbia require an external appeal or independent review process, should an individual wish to challenge their UM decision to a neutral third party (up 15 percent since 2000).

These trends demonstrate that state officials are more heavily regulating UM in order to create a formal and structured setting for its practice," said Garry Carneal, JD, MA, URAC President and CEO. "The survey findings clearly indicate that states continue to actively supervise how medical necessity review determinations are made to insure that UM decisions are made in a standardized manner based upon a sound medical basis."

The full state-by-state survey results are contained in URAC's Utilization Management Guide 3rd Edition. Included with the guide are several articles on various aspects of utilization review and UM . In addition, the guide also details the federal regulatory environment for UM, which has changed significantly since the U.S. Department of Labor's claims procedure was implemented in 2002. These regulations are the federal government's first major entry into medical management processes oversight (outside of Medicare and Medicaid).

"This guide is a definitive information source for both new and experienced health care professionals responsible for utilization management," said Charles W. Stellar, URAC Chair and executive vice president of AHIP. "Especially in light of changes to utilization management requirements brought on by new state and federal requirements, including the Medicare Modernization Act [MMA], the guide is an essential tool for all involved in the UM field."

For more information about the survey, contact Jackie Lombos at (202) 326-3943. To order the guide, go to www.urac.org .

From the Executive Director’s Desk ...

Online Membership Directory Growing

In just a few months, the IALCP online membership directory has grown to include entries for 89 members from 27 states and three Canadian provinces. Several members have contacted IALCP headquarters to ask why their names are not listed in the directory. While inclusion in the directory is a benefit of membership and comes at no cost, your name and contact information is not included automatically. You must ask to be added to the directory in writing, either by noting your request on the membership application/renewal form or by sending a brief request to IALCP headquarters (114 N.W. Fifth Street, Suite 103, Ankeny, IA 50021).

About Professional Liability Insurance

IALCP was pleased when, slightly more than a year ago, we were able to announce that we had found an insurance company willing to offer professional liability insurance specifically for life care planners. We have not been pleased, however, to learn that many of our members who purchased the coverage have not received written proof or insurance or renewal notices sent in a timely fashion. We want to ensure that our members are receiving adequate service from the insurance brokerage (CM&F Group) and the carrier (Granite State Insurance Company). To do that, however, we need your help.

• Have you received a copy of your policy from the CM&F Group?
• Have you received any other documentation showing proof of insurance?
• Have you received a renewal notice on your policy? Some members assumed their coverage remained in force when their policies actually had expired and they had not received any notice that a new one-year premium was due.

If the answer to any of those questions is "No," please let us know about it right away!

Also, several IALCP members have complained that they called the CM&F group and either were treated rudely or could not get answers to their questions – even to such a question as whether the insurance was available for life care planners. We consider the lack of information or rude treatment to be unacceptable, but we can't complain on your behalf if we don't have specific information about any problems you might be having with the brokerage. Let us know!

Our contact with the CM&F Group is Donna Fogelstrom, vice president of the company's professional liability practice. Her telephone number is 212-233-8911, extension 226. If you have any questions about at all about your insurance coverage or need assistance from the insurance brokerage, she is the person to contact. — David Fox