This CMS standard provides:

All MAOs that offer CCPs must ensure continuity and coordination of care through procedures for timely communication of clinical information among contracted network providers, with the member, and with his/her designees (if applicable).

The URAC standard implementing this is MAP-CCP2.

The Basics

This standard requires that your organization have policies and teachers to assure timely communication of clinical information among the members of your provider network, and between those providers and consumers and their families.  Those policies and procedures need to include:

• mechanisms to ensure that the organization on the network path sufficient information for quality continuous patient care and quality review;
• mechanisms for appropriate and confidential exchange of information throughout the network; and
• procedures to assure consumers have timely access to records and other information regarding their health and enrollment in health plan.

URAC Accreditation Tips

Documents be included with your desktop review submissions should include policies and procedures, the provider manual, sample provider newsletters addressing coordination of care, and the results of audits of medical records.  Member newsletters and education materials might be useful submissions, as well.

The on-site interview of the medical Director, utilization management and case management staff will include questions such as:

• What are the organization policies and procedures for care coordination?
• How are providers informed about the network care coordination services?
• Are member's medical records' audited?
• What items are on the tool ( follow-up care, education in self-care, health promotion activities, & referrals for care needs?)
• What education materials does the plan provide members to assist with coordinating their care?
• What requirements does the plan set for communication between the PCP and specialist?
• Are summaries sent to the PCP?
• A member is discharged from the hospital what is the expectation of the facility to inform the member of follow-up care needs?
• How often are enrollee member records audited?
• What policies and procedures are disseminated to providers regarding documentation guidelines?