CCMC CCMFree Certified Case Manager practice test

Correct answer: B. Rising rates of severe and persistent mental illness

The Case Management Society of America (CMSA) identifies four major factors influencing case management practice: the expansion of managed care, the growing elderly population, the increasing number of chronically ill patients, and rising state and regulatory requirements. While mental illness significantly impacts healthcare delivery, it was not among the four CMSA-designated key factors.

Correct answer: D. Between 4 and 6 patients per setting

Custodial and boarding care settings provide comprehensive care to a small number of individuals. Typically, a single custodial or boarding care setting serves between 4 and 6 patients at a time.

Correct answer: A. 10–25%

Medication nonadherence is a significant issue in case management. Failure to follow medication regimens accounts for approximately 10–25% of all hospital and nursing home admissions.

Correct answer: B. All states must offer hospice benefits for a minimum of 210 days

Under Medicaid, every state is required to provide hospice benefits for a minimum of 210 days. This is a distinct consideration from federal-level benefits and is not optional for states.

Correct answer: D. Yes

A skilled care setting can accommodate many different levels of care based on what the client requires. Level of care refers to the specific resources used to address patient needs—such as occupational therapy, physical therapy, or nursing—rather than the physical location. The skilled care setting is the place of care, not the level of care, and this distinction is not governed by state law.

Correct answer: C. Custodial care

InterQual Level of Care Criteria assist healthcare organizations in evaluating clinical appropriateness for various care settings. Criteria exist for acute pediatric care, acute rehabilitation, long-term acute care, and others. However, InterQual criteria are not available for custodial care.

Correct answer: C. Evidence-based clinical guidelines

The appropriate level of care is primarily determined through the application of evidence-based guidelines such as InterQual or the Milliman Care Guidelines. Federal law, CMS guidelines, and state boards play a lesser role, if any. While patient preferences are relevant, patients do not independently determine their own level of care.

Correct answer: D. One

The Patient Activation Model (PAM), developed by Insignia Health, is designed to engage patients through a single point of contact within the system, motivating them through a stepwise process toward greater self-engagement in their care. This principle of a single contact applies regardless of how many disciplines are involved or how many conditions exist. Patients in this model are not left to navigate the system on their own.

Correct answer: A. 2 to 3

Patients with multiple comorbidities present complex challenges. Best practice is to begin with a limited set of no more than 2 to 3 goals that the patient genuinely believes are achievable, ensuring early engagement and realistic expectations.

Correct answer: C. Palliative care

The case manager's scope of practice varies considerably across settings. In subacute care, public health programs, and acute inpatient rehabilitation, the role tends to be more administrative—focused on resource coordination, discharge planning, and care linkage. In palliative care, however, a nurse case manager frequently holds direct clinical care responsibilities.