This CMS standard provides:

The MAO has written standards for timeliness of access to care and member services that meet or exceed such standards as may be established by CMS, continuously monitors its provider networks’ compliance with these standards, and takes corrective action as necessary. The MAO ensures that the hours of operation of its providers are convenient to and do not discriminate against members. When medically necessary, the MAO makes services available 24 hours a day, 7 days a week.

The only URAC standard other than normal health plan contracting standards that URAC provides to support the CMS standard is MAP-NM 15.

The Basics

The standard requires that your organization implement standards requiring members of your provider network to consider input from the Medicare beneficiary in the provider's treatment plan.  Your organization probably carries this requirement in the provider contract, provider manual, or policies and procedures that are binding on members of your provider network.  Be sure you know which documents do this.

Management Tips

In the policy and procedure governing provider care of your members, be sure to be explicit in requiring that they incorporate beneficiary input into treatment plants.  It also makes sense to include this in provider contracts and or documents that are referenced in the provider contract, such as the provider manual or applicable policies and procedures.  In addition, your network management staff should be well-trained on the requirements of this standard.

URAC Accreditation Tips

For desktop review, submit applicable policies and procedures, language from the provider manual and provider contracts, as well as any provider newsletter articles that mention beneficiary input into treatment plans.

The on-site reviewer's interview of network management and customer service staff members are likely to move across the full range of access and availability issues, including standards for urgent and routine appointments, how access and availability is measured, whether provider availability surveys are conducted, and whether issues raised by the standard have ever come up in any consumer complaints.  The on-site document review will involve the reviewer's examination of at least 30 provider contracts, designed to find whether this requirement is included in those agreements.  Be sure to have those contracts marked and tabbed so that the appropriate contract language is easy for the reviewer to find.