Sandra Lowery, RN, BSN, CRRN, CCM
Francestown, N.H.
Years of Presidency: 2000-2001
How Legislation and Case Law Create Legal Challenges for Case Managers
“When you see NCQA spending thousands of dollars to develop standards for case management, and you see CMS coming out with new standards related to case management, I think that speaks for itself in terms of: we’re growing and we’re also being more subject to external demands on us. And with awareness comes scrutiny, and accountability.”
Introduction:
Sandra Lowery brings a rich culture to the practice of case management. Her clinical experience, which spans more than 11 years, has included time in acute care, home health, rehabilitation, oncology, and research prior to case management. This experience has enabled her to perform and prosper in independent consulting since 1986. Sandi has consulted nationally for more than 250 payer and provider organizations for case management planning, operations and training, while managing an independent case management practice. In addition to her active case management practice, she serves a role as adjunct faculty, University Systems of New Hampshire and is a clinical preceptor for case management at the University of Massachusetts. To share her broad scope of vision, Sandi also offers case management certification review programs across the country.
On the personal side, Sandi enjoys her home in New Hampshire with her husband. They also enjoy vacationing in diverse locales around the world.
Leadership Interview: Sandi talks to listeners about the legislation impacting case managers. She shares important information that case managers can use to understand the laws that guide practice, and encourages all case managers to stay up-to-date in order to be protected.
Download and listen to the interview
[10 MB WAV File]
Major Laws/Acts Impacting Case Managers
The following resources were mentioned during the interview with Sandra Lowery:
- CMS: Conditions for Participation:
http://www.cms.hhs.gov/CFCsAndCoPs/ - Emergency Medical Treatment and Active Labor Act (EMTALA):
http://www.emtala.com/ - Observation Units:
http://hpmp.tmfhqi.net/LinkClick.aspx?fileticket=hAw7LsK4o2s%3D&tabid=521&mid=1247 - Preadmission Screen and Resident Review (PASARR):
http://dhfs.wisconsin.gov/forms1/DDES/DDE2191.pdf - Nursing Home Reform Act:
http://www.aarp.org/research/legis-polit/legislation/aresearch-import-687-FS84.html - Balanced Budget Act:
http://www.cbpp.org/908mcaid.htm - Multi-State Licensure Resources:
http://cmsa.org/ADVOCACYOUTREACH/MultiStateNursingLicensure/tabid/174/Default.aspx - Medical Malpractice Case example:
http://sev.prnewswire.com/health-care-hospitals/20050721/NYTH00921072005-1.html - Legal Nurse Consultants:
http://www.aalnc.org/ - Expert Witness Qualifications:
http://www.swclap.org/EXPERTWITNESS.pdf - Case Management Standards of Practice:
http://www.cmsa.org/
