The CMS standard reads:

All MAOs that offer coordinated care plans (CCPs) must ensure continuity of care and integration of services through arrangements with community and social service programs generally available through contracting or non-contracting providers.

URAC implements this standard through URAC standard MAP-CCP 1.

The Basics

This standard requires that your organization ensure continuity of care through arrangements with members of your provider network that include programs for them to coordinate their efforts with community and social services available through both the dissipating and non-participating providers, including nursing homes and other community-based services.

URAC Accreditation Tips

The documents you will need to submit will include policies and procedures regardingco ordination of care, lists of available social services and community agencies within your service area, and documentation regarding your case management program, such as a case management manual and a case management template record.

The on-site reviewer will ask a variety of questions of the medical director and members of the case management and utilization management staff, such as:

• How does the plan assure contracted providers assist enrollees in locating necessary services social and community services, skilled care facilities? 
• How do you monitor this? 
• What can a patient expect from your contracted acute care hospital when discharged after a hip replacement? 
• Do you have any documented instance of re-admission due to incomplete discharge planning?

The on-site document review will involve a review of sample cases in order to find evidence of coordination of care.