CBHCM - Certified Behavioral Health Case Manager Legal and Regulatory Compliance Questions and Answers 1 — Questions and Answers
Question 1: A case manager is working with a client who receives services from a federally-assisted substance use disorder (SUD) treatment program. The case manager needs to coordinate care with the client's primary care physician. Under 42 CFR Part 2, what is required before the case manager can share information about the client's SUD treatment?
- A verbal agreement from the client documented in the case notes.
- A court order, as medical records are involved.
- Specific, written consent from the client authorizing the disclosure. (Correct answer)
- Standard agency consent for release of information that covers all medical records.
Correct answer: Specific, written consent from the client authorizing the disclosure.
42 CFR Part 2 provides stringent privacy protections for patients receiving treatment from federally-assisted substance use disorder programs. Unlike HIPAA, it requires specific written patient consent for any disclosure of identifying information, even for treatment, payment, or healthcare operations. A general consent form is insufficient.
Question 2: During a session, a client tells their behavioral health case manager that they have a specific plan to seriously harm a former coworker and have access to a weapon. The case manager's ethical and legal 'duty to warn' or 'duty to protect' obligations, stemming from the Tarasoff v. Regents of the University of California case, require them to:
- Immediately hospitalize the client involuntarily to prevent harm.
- Maintain strict client confidentiality above all else.
- Break confidentiality and take reasonable steps to protect the potential victim. (Correct answer)
- Only document the threat in the client's record and increase session frequency.
Correct answer: Break confidentiality and take reasonable steps to protect the potential victim.
The 'duty to warn' or 'duty to protect' principle, established by the Tarasoff case, creates an exception to client confidentiality. When a client communicates a serious threat of physical violence against an identifiable victim, and has the apparent intent and ability to carry out the threat, the professional has a legal and ethical obligation to take reasonable steps to protect the potential victim. This may include warning the intended victim and notifying law enforcement.
Question 3: Which of the following is a key element of obtaining legally valid informed consent for services from a behavioral health client?
- Ensuring the client signs the consent form before the first appointment.
- Having a legal guardian sign for all adult clients, regardless of their capacity.
- Providing the client with a standardized brochure about the agency's services.
- Disclosing the purposes, risks, benefits of services, and available alternatives in an understandable way. (Correct answer)
Correct answer: Disclosing the purposes, risks, benefits of services, and available alternatives in an understandable way.
Informed consent is a process, not just a form. For consent to be legally valid, it must be voluntary, and the client must be knowledgeable and competent. This requires the case manager to explain, in language the client can understand, the purpose of the services, the potential risks and benefits, any alternative options, and the client's right to refuse or withdraw consent.
Question 4: A case manager in Florida is working with an adult client who is experiencing an acute mental health crisis. The client is refusing a voluntary examination but is unable to determine that examination is necessary for their own safety and, without care, is likely to cause serious bodily harm to themselves. Which Florida-specific law provides the legal framework for initiating an involuntary examination?
- The Marchman Act
- The Americans with Disabilities Act (ADA)
- The Health Insurance Portability and Accountability Act (HIPAA)
- The Baker Act (Florida Mental Health Act) (Correct answer)
Correct answer: The Baker Act (Florida Mental Health Act)
The Florida Mental Health Act, commonly known as the Baker Act, allows for the temporary, involuntary examination of an individual. The criteria for a Baker Act include reason to believe the person has a mental illness and, because of it, is refusing voluntary examination or is unable to determine if it's necessary, and there is a substantial likelihood they will cause serious bodily harm to themselves or others in the near future.
Question 5: When a client's information is protected by both HIPAA and 42 CFR Part 2, how must a behavioral health case manager handle a request for disclosure?
- Follow HIPAA guidelines as it is the more recent federal law.
- Choose the regulation that is less burdensome for care coordination.
- Adhere to the requirements of the more restrictive regulation. (Correct answer)
- Allow the client to verbally choose which regulation to follow for the disclosure.
Correct answer: Adhere to the requirements of the more restrictive regulation.
When two laws govern the same information, practitioners must follow the stricter or more protective law. 42 CFR Part 2 is generally more restrictive than HIPAA regarding the confidentiality of substance use disorder records, especially concerning consent for disclosure. Therefore, the case manager must comply with the more stringent requirements of 42 CFR Part 2.
Question 6: A client has a legal guardian appointed by the court. The case manager needs to develop a service plan. What is the case manager's responsibility regarding informed consent?
- Obtain consent only from the client, as it is a person-centered plan.
- Obtain informed consent from the legal guardian, who has the authority to make decisions.
- Proceed with the plan without consent, as the client is under court order.
- Involve the client to the greatest extent possible, but obtain legal consent from the guardian. (Correct answer)
Correct answer: Involve the client to the greatest extent possible, but obtain legal consent from the guardian.
While a legal guardian holds the legal authority to provide consent for an individual deemed incapacitated, best practices in person-centered care demand the client's involvement in the process to the fullest extent of their ability. The case manager must obtain the legal consent from the appointed guardian but should also explain the plan and seek the client's assent and participation in a way they can understand.
CBHCM - Certified Behavioral Health Case Manager Legal and Regulatory Compliance Questions and Answers 1
A case manager is working with a client who receives services from a federally-assisted substance use disorder (SUD) treatment program.
The case manager needs to coordinate care with the client's primary care physician.
Under 42 CFR Part 2, what is required before the case manager can share information about the client's SUD treatment?