The Basics

This standard focuses on the list of “rights and responsibilities” your program provides to people when they first enroll in the DM program.  Specifically, those rights and responsibilities must include the right to:

• Know about the program’s philosophy and characteristics;
• Have PHI shared with other entities only in accord with federal and state law;
• Know a unique identity (if not the full name) and the job title of the DM staff member to whom he/she is talking, as well as the right to talk to that person’s supervisor, on request;
• Receive accurate information from the program;
• The receipt of accurate administrative information in the event of changes or termination of the program;
• Withdraw from the DM program at any time;

They must also include the responsibility to:

• Submit appropriate, required forms to participate in the program;
• Give accurate information to the program and to let the program know of any changes in that information;
• Tell the treating provider that they are participating in the program.

Your program likely provides this information both in paper and electronic form, so familiarize yourself with the particular ways your program uses to convey this information.

Management Tips

The easiest way to address this is to create a single document and a Web page that lists these rights and responsibilities (and others, if appropriate).  You’ll probably be safer developing your own, rather than relying on your clients’ communications; health plans’ rights and responsibilities documents seldom contain the level of detail and specificity about disease management that is required by this standard.  It will not suffice that the consumer receives information about other programs (e.g., UM, CM).

The time frame for conveying this information to the consumer is either before enrollment or upon enrollment, and no more than 30 days after enrollment.

URAC Accreditation Tips

Each of the nine elements of this standard is weighted 4.

For the desktop review phase, submit the documents and/or screen shots of the web pages conveying the information required by this standard.

The onsite review will involve another review of the documentation you submitted at the desktop phase.  It also will involve an interview of the members of the DM staff about how they notify members of their rights and responsibilities.