The Basics

This standard outlines the basic requirements regarding the DM program’s contact with consumers.  There should be a document that specifies:

• The period of time after identification of the consumer as eligible for the program within which the program should initiate contact;
• How and how often the program contacts consumers;
• The method of documenting consumer contacts;
• The means by which the program reports the effectiveness of consumer engagement to the program’s clients; and
• How the program communicates its consent policies to consumers.

Your best preparation will be to locate and review that document.

Management Tips

While URAC gives your program a lot of flexibility around consumer contacts, it does prescribe a maximum of 3 months from consumer identification as the limit for initial contact.  Documentation of a good faith attempt to contact within that period of time will suffice; actual contact is not required.  The documentation should describe what method(s) should be used to contact the eligible consumer.

URAC Accreditation Tips

The five elements of the standard range from 2 to 4 in weight.

The documentation to be submitted to URAC via AccreditNet should include the P&Ps and any supporting documents like timelines, consent forms, or flowcharts.  In addition, you should submit sample client reports indicating consumer contacts, attempted and successful.  Screen shots of the tracking system, too, are acceptable submissions. 

The onsite reviewer will interview members of the staff about consumer contact processes.  Questions may include:

• How soon after a person is identified as being eligible for the DM program must you contact them?
• How do you contact them?
• How frequently should you be contacting a participant in the program? 
• Does your prescribed frequency of contact vary, depending on the clinical condition of the consumer or the level of his/her stratification?
• What is the mechanism for documenting the fact that you attempted to contact the consumer?
• How do you document the consumer’s consent to be in the program?

In addition, the reviewer will want to see client-specific reports with consumer contact information.  Finally, the reviewer’s examination of consumer case files will include an assessment of whether he/she has been contacted within the proper time after being identified as being eligible for the program.