CCMC Applauds NAIC Decision to Include Case Management in Medical Loss Ratio
MLR Calculation Recognizes Value of Case Managers
Mount Laurel, NJ (PRWEB) August 31, 2010
The Commission for Case Manager Certification (CCMC) today praised the National Association of Insurance Commissioners’ recommendation that case management be included in the medical loss ratio (MLR) formula, in recognition of the role these professionals play in directly benefiting patients.
With nearly 30,000 professionals currently holding the CCM® credential, CCMC is the largest nationally-accredited organization certifying case managers from across all disciplines. In July, CCMC submitted comments to the NAIC to advocate on behalf of the case management field. This letter states that case management services, as defined by CCMC and when practiced by qualified clinical professionals, should be recognized as medical or quality improvement activities, and thus be included in MLR-allowed expenses.
“The NAIC had a difficult task in formulating the MLR calculation. CCMC is pleased to see the calculation recognizes the importance of case management services,” said CCMC Board Chair Annette Watson. “Case management can contribute to improving quality of care, patient safety and health care outcomes, while controlling health care costs, when it is performed by qualified clinical professionals, in accordance with CCMC standards.”
In its recently-submitted comments to NAIC, CCMC outlined how case management is clearly a clinical activity essential to the attainment of desired outcomes. Case management must be practiced by clinical, licensed and certified health and human services professionals, such as those who meet qualifications by becoming Certified Case Managers (CCMs). CCMC further believes that, through certification, case managers are able to demonstrate their competency to practice independently, promote quality and safety and protect the public.
“Including case management in the MLR validates that these services improve quality. This is particularly important given the emphasis on care coordination in health care reform,” Watson added. “The competency of the individuals providing these services will directly impact the success and outcomes of care coordination. Certified case managers, through education, experience and examination, have demonstrated their ability to fulfill this role and can contribute to the attainment of health care reform goals by leading the care coordination effort.”
About CCMC
The Commission for Case Manager Certification established the standard for case management credentialing. The nationally accredited CCM® certification exam, which is continuously validated through evidence-based research, is a widely sought certification by employers. To learn more, visit http://www. ccmcertification. org/ (http://www. ccmcertification. org/), connect with CCMC on Facebook and follow CCMC on Twitter @CCM_Cert.
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