This CMS standard provides:

The MAO implements procedures to ensure that members are not discriminated against in the delivery of health care services consistent with the benefits covered in their policy based on race, ethnicity, national origin, religion, sex, age, mental or physical disability or medical condition, sexual orientation, claims experience, medical history, evidence of insurability (including conditions arising out of acts of domestic violence), disability, genetic information, or source of payment. 

The URAC standard supporting this standard is MAP-AD 1.

The Basics

The standard sets forth a long list of factors that your organization may not use to deny, limit, or condition coverage or benefits:

• Mental or physical disability or condition;
• Claims experience;
• Receipt of health care;
• Medical history;
• Genetic information;
• Evidence of insurability, including conditions arising out of acts of  domestic violence;
• Disability;
• Race;
• Ethnicity;
• National origin;
• Religion;
• Sex;
• Age;
• Sexual orientation; or
• Source of payment.

Make sure you can find the organizational document(s) that explicitly implement this standard.

Management Tips

A general anti-discrimination clause will not suffice.  You need to be as specific, both in your P&Ps and in your staff training, as is the standard.

URAC Accreditation Tips

The desktop review submissions should include very specific applicable policies and procedures and/or applicable sections from the provider manual.  In addition, agendas and attendance sheets from staff orientation and training classes on this topic of anti-discrimination should be submitted.  Any other organizational documents that address anti-discrimination would be useful, too.

The on-site review interview will be targeted at the member services and provider relations staff members.  Three main questions that are likely to be asked are:

• How is antidiscrimination addressed in provider contracting?
• Did you receive any training pertaining to discrimination?
• How are members informed of their rights?