The Basics

This standard requires your program to spell out in a policy and procedure how it provides information to consumers who might benefit from other resources that might be available to them both from the purchaser and/or the external health-care system.  Naturally, this applies only in those cases where your program has been contracted to provide this kind of coordination service.  Check your program's documentation to be sure you are familiar with whether and how your organization provides this kind of referral information.

An example of this kind of coordination might be if you refer a consumer to specialty programs offered by the purchaser or to targeted services offered by a community health organization.

Management Tips

You will need a policy and procedure explicitly addressing this issue.  That policy and procedure should provide clear instruction to staff, including scripts where appropriate, on when and how such referrals must be made.  In addition, staff must be trained in how to document those referrals for each consumer where appropriate.

URAC Accreditation Tips

Both elements of the standard are mandatory.

For the desktop review, submit the required policy and procedure as well as any templates and scripts guiding staff members on how to conduct these referrals.

The key to the on-site review is that your staff members who might make such referrals be well-trained in how to do so consistent with your organization's policies.