Case management and disability management

To find an applicant eligible for state VR services, the counselor must establish that the physical or mental impairment:

1. is a substantial impediment to employment
   VR eligibility requires an impairment that is a substantial impediment to employment, plus the need for VR services to get or keep a job.
2. prevents the applicant from any work
   VR serves people who can work with services, so an impairment that prevents all work points away from the program's purpose.
3. meets an SSA disability listing
   Meeting an SSA listing is not required; SSI or SSDI recipients are presumed eligible, but many eligible applicants do not receive benefits.
4. is permanent and not expected to improve
   VR eligibility does not require a permanent impairment; this option mixes in a disability insurance idea.

A case manager paid by an insurance carrier finds that the least costly service option would not meet the client's documented medical needs. The case manager should:

1. defer entirely to the treating physician
   The physician's input matters, but handing over the decision entirely gives up the case manager's own duty to coordinate and advocate.
2. recommend the least costly option
   Choosing the cheapest option despite unmet needs puts the payer's interest ahead of the client's welfare.
3. withdraw from the case
   Withdrawing abandons the client; a payer relationship is managed by disclosure and advocacy, not by leaving the case.
4. advocate for adequate treatment
   Ethical case managers advocate for the services that meet the client's documented needs, even when a third party pays, while being open with the payer about their reasoning.

A counselor refers a client to a community mental health center. Which action BEST completes the referral function of case management?

1. Sending the client's entire case file to the center
   Sharing the whole file breaks the minimum-necessary principle and needs consent; send only what the service needs.
2. Referring to several agencies at once to raise the odds
   Scattered referrals confuse the client and duplicate services; good referral is targeted and coordinated.
3. Confirming the client connected with the service
   A referral is complete only when the client actually connects; following up closes the loop and catches barriers such as a long waitlist or missing transportation.
4. Giving the client the center's phone number
   Handing over a phone number starts a referral but does not finish it; without follow-up, many clients never connect.

A state VR agency receives a completed application on March 1. Absent an agreed extension, the eligibility decision is due by about:

1. August 28
   August 28 is about 180 days out, triple the 60-day federal deadline.
2. May 30
   May 30 is about 90 days, which is the IPE deadline after eligibility, not the eligibility deadline.
3. March 31
   Thirty days is shorter than the rule; the federal standard is 60 days.
4. April 30
   Federal VR rules require an eligibility decision within 60 days of a completed application unless the applicant agrees to an extension or trial work experiences are needed; 60 days from March 1 is about April 30.

A client is admitted to inpatient rehabilitation after a stroke. Discharge planning should begin:

1. during the final week of the stay
   Starting in the final week leaves too little time to arrange equipment and community services.
2. after the client returns home
   Planning after discharge leaves the client without services during the riskiest transition.
3. at admission
   Discharge planning starts at admission so equipment, home changes, services, and caregiver training are ready when the stay ends.
4. once a discharge date is set
   Waiting for a set date compresses planning and causes delays or unsafe discharges.

A counselor returns from leave to four messages. Which should be returned FIRST?

1. A client who wrote she 'can't go on like this'
   A statement such as "can't go on like this" may signal suicidal thinking, so this client is contacted first to assess risk; safety comes before logistics.
2. A provider requesting a signature on an overdue invoice
   An administrative task has the lowest priority, however overdue it is.
3. A client requesting a bus pass for tomorrow's interview
   Tomorrow's interview is time-sensitive, but a transportation need is not a safety risk and can follow the risk check.
4. An employer asking about next week's accommodation deadline
   A deadline next week leaves time; employer relations matter, but not more than a possible crisis.

A client who sees a private therapist asks her VR counselor for personal counseling on the same issues. The counselor should:

1. provide the counseling as requested
   Providing parallel personal counseling without coordination risks working at cross-purposes with her therapist.
2. advise the client to stop seeing the therapist
   Telling her to drop her therapist oversteps and may harm an established treatment relationship.
3. seek consent to coordinate with the therapist
   When a client is already in counseling elsewhere, the counselor asks for a release to coordinate with the therapist so services do not overlap or conflict.
4. decline to serve the client while she is in therapy
   Being in therapy does not make her ineligible for rehabilitation counseling; coordination, not refusal, is called for.

A client with schizophrenia has repeated hospitalizations, frequent homelessness, and rarely keeps office appointments. Which service model BEST fits these needs?

1. Broker case management
   Broker case management only links clients to services; it lacks the intensity and outreach his needs call for.
2. Assertive community treatment
   ACT provides a multidisciplinary team that meets clients in the community around the clock, which suits people with frequent hospitalizations, homelessness, and missed office visits.
3. A clubhouse program
   A clubhouse is a voluntary, member-run program that depends on members attending; it does not provide outreach and crisis care.
4. Weekly office-based outpatient therapy
   He rarely keeps office appointments, so an office-based model will not reach him.

A client says his job-search workshop is going well, but the provider reports he attended 2 of 10 sessions. The counselor should FIRST:

1. accept the provider's report and note noncompliance
   Labeling him noncompliant before hearing his side skips assessment and may hide a solvable barrier.
2. ask the provider to discharge him from the workshop
   Discharging him is a punitive step taken before anyone knows why he missed sessions.
3. discuss the discrepancy with the client
   The first step is to raise the gap with the client openly and nonjudgmentally to learn what is getting in the way, such as transportation, anxiety, or schedule conflicts.
4. accept the client's report as accurate
   Ignoring the attendance record to protect rapport avoids the problem; honest discussion strengthens the working relationship.

A workers' compensation carrier's nurse checks whether 12 more physical therapy sessions are medically necessary before approving them. This process is:

1. an independent medical examination
   An IME is a physical examination of the worker by a non-treating physician; this nurse is reviewing a treatment request on paper.
2. utilization review
   Utilization review checks whether proposed care is medically necessary and appropriate before or while it is paid for.
3. peer consultation
   Peer consultation is a clinician seeking colleagues' advice, not a payer's coverage decision.
4. case finding
   Case finding locates potential clients; it has nothing to do with approving therapy sessions.

A short-term disability policy has a 7-day elimination period. An employee is unable to work for 10 days after an illness. For how many days are benefits payable?

1. 3 days
   The elimination period is the waiting time before benefits begin; after 7 unpaid days, benefits cover days 8 to 10, which is 3 days.
2. 10 days
   Paying all 10 days ignores the elimination period, which is not covered.
3. 17 days
   Adding the elimination period to the absence double-counts; it is subtracted from the time off, not added.
4. 7 days
   Seven days is the unpaid waiting period itself; this option confuses the elimination period with the benefit period.

Two clients with the same disability live in different states and receive different Medicaid services. The main reason is that Medicaid:

1. eligibility is set by each county
   Counties may handle applications, but eligibility rules are set at the state level within federal requirements.
2. rules are set by SSA field offices
   SSA runs SSI and SSDI; Medicaid policy is set by the state Medicaid agency and CMS, not by SSA offices.
3. is funded entirely by the state
   Medicaid is jointly funded, with the federal government paying a large share through matching funds.
4. is run by states under federal rules
   Medicaid is a federal-state partnership: states run their own programs within federal rules, so covered services, waivers, and eligibility details differ by state.

A construction worker injures his back on the job and cannot work at all for two weeks while he undergoes physical therapy. During this period he most likely receives:

1. temporary total disability benefits
   Temporary total disability benefits replace part of wages while the worker cannot work at all and is still healing.
2. temporary partial disability benefits
   Temporary partial benefits apply when the worker can do some work at reduced earnings during recovery; here he cannot work at all.
3. permanent partial disability benefits
   Permanent partial benefits come after MMI for lasting impairment; he is still in treatment.
4. permanent total disability benefits
   Permanent total disability is for workers who can never return to gainful work; a two-week absence is neither permanent nor total in that sense.

For an injury to be compensable under workers' compensation, it must generally:

1. be reported to the employer within 24 hours of injury
   Reporting deadlines exist but vary by state and are usually longer; late reporting can complicate a claim but is not what makes an injury compensable.
2. arise out of and in the course of employment
   Workers' compensation is no-fault: the injury must arise out of and occur in the course of employment, whoever was at fault.
3. result from the employer's negligence
   Workers' compensation does not require proof of employer negligence; it replaced fault-based lawsuits with no-fault coverage.
4. cause a permanent physical impairment
   Temporary injuries are compensable too, and many claims pay only medical care and temporary benefits.

A worker recovering from a heart attack is cleared to work 4 hours a day, increasing each week until full time. This arrangement is a:

1. permanent partial disability rating.
   A permanent partial disability rating measures lasting impairment after MMI; it is not a schedule for returning to work.
2. graduated return to work.
   A graduated return to work increases hours step by step toward full time, easing a worker back after illness or injury.
3. work conditioning program.
   Work conditioning is an exercise program done before returning to work, not the reduced-hours return itself.
4. job carving arrangement.
   Job carving builds a new position from parts of other jobs; this worker keeps his own job on a reduced schedule.

A client with progressive multiple sclerosis who has Medicare needs a power wheelchair for use at home. Which part of Medicare covers this durable medical equipment?

1. Part B
   Medicare Part B covers durable medical equipment such as power wheelchairs used in the home when a physician documents medical need.
2. Part A
   Part A covers hospital, skilled nursing facility, and hospice care, not equipment for home use.
3. Part D
   Part D covers outpatient prescription drugs, not equipment.
4. Medigap only
   Medigap plans help pay Part B cost-sharing, but the coverage itself comes from Part B.

A client with heart disease has just been awarded SSDI and worries about health coverage. Medicare generally begins after:

1. the 5-month SSDI waiting period
   The 5-month waiting period delays cash benefits; Medicare comes much later, after 24 months of entitlement.
2. 12 months of SSDI entitlement
   Twelve months is half the actual Medicare waiting time for most SSDI beneficiaries.
3. the first SSDI check is paid
   The first check starts the 24-month count; coverage does not begin then.
4. 24 months of SSDI entitlement
   Medicare starts after 24 months of SSDI entitlement, which is about 29 months after disability onset once the 5-month waiting period is counted; ALS and ESRD are exceptions.

In conceptualizing a case, a counselor considers the client's diabetes, depression, limited family support, and lack of transportation as interacting influences on employment. This approach is best described as:

1. biomedical model
   A biomedical model would focus on the diseases alone and leave out family support and transportation.
2. psychodynamic
   A psychodynamic view focuses on unconscious conflict, not on medical and social influences on employment.
3. biopsychosocial
   A biopsychosocial approach weighs biological (diabetes), psychological (depression), and social (support, transportation) factors as interacting influences.
4. trait-factor
   Trait-factor theory matches personal traits to job requirements; it does not conceptualize interacting health and social barriers.