The Basics

This standard requires that your organization periodically reassess each consumer participating in the DTM program to determine whether:

• prescription drugs continue to be appropriate for the consumer's disease, response, and condition;
• the consumers experiencing adverse effects of the drug;
• consumer is benefiting from the drugs; and
• the consumer is adhering to drug therapy.

Another way to look at these four requirements is that they are about appropriateness, safety, and effectiveness.

Your organization's DTM program description should have guidelines for your reassessment processes for your particular DTM approach.  Be sure you are familiar with that description.  In addition, it will be important that employees conducting the reassessment document each action concerning the reassessment according to the organization's policies and procedures.

Management Tips

Again, the DTM program description is the key document.  Make sure it has a section called "reassessment" or some similar title, in which you have a detailed description of the reassessment approach.

In addition, make sure that your staff is trained in proper documentation of the conduct of the reassessment for each consumer.

URAC Accreditation Tips

The element requiring reassessment to determine whether there are adverse effects is a mandatory element.  The other three elements are weighted 4.

The DTM program description should be sufficient for the desktop review phase.

The on-site reviewer will talk with clinical staff about the reassessment process.  In addition, he/she will examine case files for evidence of implementation of the reassessment process.