NURS FPX 4065 Assessment 3 Ethical and Policy Factors in Care Coordination

Ethical and Policy Factors in Care Coordination

Student Name

Capella University

NURS-FPX4065

Instructor’s Name

Submission Date

Slide: 01

My name is _________, and in this presentation, today, what I intend to bring out is some of the ethical and policy matters that influence the coordination and continuum care within Immersion Residential. As I am a nurse with practice experience in a behavioral health and detox setting, I will be indicating how the practice is informed by our government and the American Nurses Association (ANA) Code of Ethics in terms of my practice with the vulnerable.

Slide: 02

The existence of governmental policies and moral values produces an enormous impression on the organization and continuum of care within behavioral healthcare institutions. Since it is a detox and mental facility, and a mental health care facility called Immersion Residential, the process of care provision must be associated with Federal and state, and local regulations and provisions of professional ethics. Some of these policies, such as the Affordable Care Act (ACA), 42 CFR Part 2, and Florida Substance Abuse and Mental Health (SAMH) Program, have an effect on the way in which services may be accessed, transferred, and directly reported.

Meanwhile, the code of ethics developed by the American Nurses Association (ANA) provides important principles to practice the corresponding equality in treating people and eradicate the disparities (American Nurses Association, 2025). This presentation has tried to discuss the implications of these regulations and ethical principles on the problem of care coordination, especially with the vulnerable and underrepresented populations.

Slide: 03

Effect of Governmental Policies on Coordination of Care

The government’s issues of health policies play a critical role in the provision and integration of care, especially to the vulnerable population, detox, and behavioral health care provision services. All these policies at Immersion Residential directly influence how care is accessed, documented, transitioned, and ethically taken up along the continuum.

The policies affect the provision, sharing, and transfer of care among different service providers (Maddox, 2024). In the analysis of ACA, 42 CFR Part 2, and the Florida SAMH Program, I will highlight the role the federal and state regulations play in integrating nursing care and the same regulations facing the given process. Each of these policies has some implications for access, privacy, funding, and interdisciplinary collaboration.

Slide: 04

Affordable Care Act

One of the most promising federal policies, which affects care coordination, is the Affordable Care Act (ACA). It has made the declaration that mental health and substance use disorder services are a necessary health benefit, and the insurance companies will be required to cover such services just like covering medical and surgical benefits. To support the absence of continuity, ACA continues to implement the concept of integrated care, such as Patient-Centered Medical Homes (PCMHs) and Accountable Care Organizations (ACOs), which allow the reduction of care fragmentation and its enhancement (Patel et al., 2020).

ACA has given more access to treatment to patients who are not insured at Immersion Residential. Therefore, care coordinators must negotiate all types of insurance policies, guarantee behavioral health insurance, and facilitate the inpatient detox and outpatient or residential psychiatric care transfers. The increased workload of patients and the existing care opportunities require the enhancement of the interaction between the vendors, insurance providers, and the community resources that supply safe and timely treatment.

Slide: 05

42 CFR Part 2 – Federal Confidentiality Regulation

The Code of Federal Regulations 42 CFR- Part 2 safeguards the privacy of patients who have received treatment associated with substance use disorder (SUD). Unlike the general HIPAA rules, the specified rule has stricter rules on the disclosure of SUD treatment information even to other medical workers without the explicit written consent of a patient (Tovino, 2021). In spite of the fact that this policy is necessary in order to maintain privacy and achieve reduced stigma, it can raise some logistical and ethical concerns in the context of care coordination.

To provide an example, since at the time of the patient leaving detox in Immersion Residential, they are referred to a community mental health provider, a care coordinator cannot exceed in dispensing with the key information on the treatment unless the patient has signed a written agreement of the same. It can lead to delays in discharge planning, medication reconciliation, and follow-ups, which can affect the treatment outcome.

Slide: 06

Florida’s Substance Abuse and Mental Health Program 

The SAMH Program in the State of Florida, with the information about financing mechanisms, licensing arrangements, standards of service, and performance expectations of the centers providing behavioral health services, is granted by the Department of Children and Families (DCF). This policy influences the organization and coordination of the services with vulnerable populations and, specifically, with uninsured or underinsured populations (McGinty & Daumit, 2020). Under the Immersion residential case, SAMH funding will enable the company to offer mental health and detox services to individuals without personal insurance.

However, it also puts much of the responsibility on the care coordinators to take custody of the eligibility papers, submit a report on the result of the service achievement, and fulfill the instructions provided by the Department of Children and Families. In addition, standardized person-centered care plans developed in collaboration with community-based providers (such as the importance of planned care transitions) are also part of the program.

Slide: 07

Ethical and Policy Considerations in Care Coordination

Care coordination relies on the national policies, state policies, and even local policies, which could coordinate care by sealing gaps between different services or even increasing the gaps between services, which most of the time bring ethical dilemmas on the part of the provider. The ACA has also expanded mental health and substance use disorder services in the country through care parity.

However, it cuts off undocumented individuals from many federal benefits, bordering on ethical viewpoints of fairness and just care. It is ethically straining on the care coordinators, as McKeown (2023) has highlighted, whereby the care coordinators must negotiate the treatment plan of the patients who might be in a position to receive treatment only during an emergency. 

At the state level, Florida has boosted its Medicaid Behavioral Health Services Program on substance use and co-occurring disorders in terms of the services and funds. This has led to a hindrance to the lifelong care of the patients transferred to residential care because of the strictness of the eligibility criteria and the lack of coordination in the managed care. This presents the principles of beneficence and nonmaleficence since the caregivers discharge patients without a chance of receiving follow-up care owing to red tape or insurance limitations.

Such policies on obligatory disclosure of any suspected use of drugs during pregnancy have no ethical ground in the region. Ajluni (2023) discovered that these policies are capable of protecting the health of the population; though, they place restrictions on the autonomy, especially in situations where patients do not accept the treatment or underestimate their symptoms because of the legal considerations.

Slide: 08

Impact and Consequences of the Policies

In the case of Immersion residential, the ACA recommendation of integrated behavioral health services has led to interprofessional collaboration among the therapists, nurses, and case managers to aid in a transition of the patient between the detoxification and long-term recovery settings.

However, as suggested by Isaacs and Mitchell 2024), it also increases the load of documentation and adds the level of administrative control, which will likely delay the process of decision-making for treatment and face-to-face relationships with the patients. This has resulted in the expansion of Medicaid in Florida, which allows more low-income individuals with substance use disorder access to detox services. Nonetheless, as McIntyre et al. (2024) claim, the continuity of care gap happens when Medicaid coverage is not paid at the time of admission. 

This disrupts the process of discharge treatment and causes the individual to join long-term residential treatment, which results in more relapses. The issue of care coordination is enhanced by national mandatory policies. Employees must make decisions on how to go about their duty to disclose and their relationship with patients as therapists. This kind of tension normally leads to poor relationships between patients and providers since patients will end up abandoning their care, fearing legal charges. All these outcomes show the adverse consequences that may occur as a result of the existence of good intentions policies on clinical outcomes and the provision of ethical care.

Slide: 09

Impacts at the National, State, and Local Levels

At the national level, ACA has emphasized the aspects of outcome-oriented care and accountability in the behavioral sector, which require a great amount of documentation, follow-ups, and audits. Al-Busaidi et al. (2025) state that it is an aspect that contributes to provider burnout and deprives caregivers of direct contact with patients, which complicates the provision of custom care in acute centers such as detox centers.

At the state level, Florida has increased its Medicaid coverage; however, the situation is oversaturated. According to Palomin et al. (2023), another area with an exceptionally long wait time before having a behavioral specialist is rural and minority groups, which is also mentioned by the California Health Care Foundation in other locations. This endangers the availability of equal access and affects the correct transitioning of treatment.

On a local level, the conflict between personal freedom and the requirements of community health during the COVID-19 pandemic also existed in the form of mask-wearing and vaccination in Broward County. Zimmerman et al. (2022) indicate that misinformation and vaccine hesitancy posed a problem in terms of the organization of the care and discharge plan of unvaccinated patients, as well as the transfer of the last category to the facilities with high requirements that could not afford any type of infection. Employees also had to find a middle ground between patient autonomy and safety in the collective treatment setting.

Slide: 10

The Role of the Code of Ethics in Care Coordination

The ANA Code of Ethics is a document that was developed to establish the course of care or connectivity within the immersion residential, a behavioral health and detox facility. The Code serves as an unconditionally relative guideline in the practice of nurses, referring to the work with the vulnerable groups of people, including those who are homeless or addicted, have untreated mental diseases, or are of poor status. The majority of them suffer such struggles in addition to the inability to obtain insurance, support at home, or live without stigma.

The ANA Code suggests nurses must safeguard the interests of patients with systemic barriers by offering more than symptomatic care, such as social determinants of health, such as housing, mental health care, and substance use recovery (Numminen et al., 2024). The nurses, therefore, should have ethical roles in making sure that all people get just and humane treatment regardless of whether they are present at any given time or not.

In the case of Immersion Residential, this model of ethics can be implemented virtually in a highly interdisciplinary partnership of nurses, case managers, social workers, and community-based organizations. Greater utilization of the domestic resources and development of the teams of care providers, which are patient-centered, enables the staff to focus not only on the short-term clinical problems of the patients but also on their psychosocial realities in the long run. As an example, the post-discharge outpatient therapy, sober living homes, and vocational support are connected with patients and reduce relapse and readmission rates.

It has been proven that a comprehensive team model of this nature encourages a huge beneficial shift in health and continuity of care, the majority of which are underserved groups (Kongkar et al., 2025). Through that, the promotion of health equity and disparity reduction in the behavioral health system, not only in everyday clinical practices, but also in the more massive projects, is guided by the Code of Ethics.

Slide: 11

Factors Contributing to Health Disparities and Access to Services

ANA Code of Ethics assists in organizing care coordination and continuum of care in Immersion Residential, a detox and behavioral health center. Being prescribed by such values as respect for human dignity, justice, and beneficence, the Code encourages nurses to consider the interests of vulnerable groups, such as the homeless, addicted, mentally ill, and poor, who lack insurance, cannot afford good housing, and are limited in possibilities to receive long-term care (Varkey, 2020).

This ethical duty of the nurses is fulfilled in Immersion Residential through the role played by the nurses in cooperation with the case manager, the social worker, and the community-based organizations to meet the needs of the patient, which might solely involve medical attention but might involve psychosocial and economic needs. The provided interdisciplinary model also assumes fair and person-centered care and contributes to achieving long-term recovery, which is also justified by the research results that conclude that interdisciplinary care that takes place in teams is highly effective in terms of improvements among underserved populations (Kongkar et al., 2025). The Code of Ethics, thus mentioned, plays a significant role in eradicating inequalities, improving health equity, and offering full and loving care to people in the continuum through nurses.

Slide: 12

Conclusion

Governmental policies and the ANA Code of Ethics are significant factors in establishing coordinated, ethical care at the Immersion Residential. The frameworks help to support the provision of equalized holistic services to patients with complex needs. The policies that impact access and care provision are the ACA, the 42 CFR Part 2, and the SAMH program of Florida. The Code of Ethics gives nurses the information on how they can serve the interests of vulnerable populations and preserve the dignity of the patient. Together, they enhance positive health outcomes and reduce behavioral health treatment disparities.

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