The Basics

This standard requires that your organization have the capacity to coordinate care for those consumers that have care management plans.  The organization has a lot of flexibility in how to comply with this standard.  Options include:

• appropriate sharing of clinical information across the array of providers involved in the consumer's care;
• improving communication among DTM providers to information technology;
• enhancing the process by which providers can refer a patient to one another; or
• care coordination including a description of appropriate activities, identification of appropriate service providers, and care transition.

If your organization has chosen the sharing of information assets methodology for complying with the standard, it will be important that the processes include appropriate consent and other mechanisms for complying with applicable privacy rules.

Management Tips

Your program description or applicable policies and procedures should be explicit about which care coordination methodology or methodologies your organization has chosen, in which members of your staff are responsible for implementing those methodologies.  Issues such as comorbidity, privacy, and consumer information handling processes should be included in the documentation.

URAC Accreditation Tips

The various elements of the standard are weighted either 3 or 4.

The policies and procedures outlining your care coordination methods is the only documentation that you need to submit for the desktop review.

The on-site review will involve both an examination of consumer records and interviews with the involved clinical staff members.