The Basics

This standard imposes a number of requirements on the DM program regarding what you tell eligible consumers about the program.  The program must let eligible consumers know about:

• Any relationship between the program and the client;
• What the criteria for eligibility for the DM program are;
• How to opt in or opt out of the program;
• How to contact the program in both urgent and non-urgent circumstances;
• What the health benefits are from program participation;
• Whether there are restrictions or incentives in the DM program (not the health plan) that may affect the participating patient (e.g., in-network or formulary requirements, financial incentives such as premium reductions for participation).
  DM programs typically provide this information in any of a number of different ways, including mail, email, fax, Web sites, etc. 

Management Tips

Be sure you take a comprehensive view of your communications materials as you inventory your total message to consumers.  It is also important to remember that not everyone has access to the internet, so your communications mechanisms should take that into account.

URAC Accreditation Tips

All six elements of this standard are weighted 4.

For purposes of the desktop review, submit a variety of consumer communications materials, ranging from scripts, written materials (including brochures and letters), and check-lists used by staff members in their communications with consumers.  In addition, submit a P&P that describes opt-in or opt-out procedures.

The onsite reviewer will examine consumer communications materials.  However, the heart of the onsite review will be an interview with staff members to verify implementation of this standard’s requirements.  Questions may include:

• How do you handle and track a consumer’s request to opt-out or disenroll from your program?
• What is your procedure in the event that you find yourself on a phone call with someone who is threatening suicide?
• What information do you send to consumers when they first enroll in your program?