The Basics

The CMS standard is:

The MAO must establish written standards for provider consideration of member input into the proposed treatment plan and for advance directives.

URAC Accreditation Tips

Documents to submit in the desktop review phase include policies and procedures, and any portion of the provider manual or provider newsletters that address patient involvement in proposed treatment plans and communications around advanced directives.  In addition, any medical record audits that get at this issue, as well as any member educational materials, including newsletters, would be good to submit here.

The on-site review will involve an interview of the medical director, and members of the provider relations, case management, and utilization management staff.  Questions will include:

• How are providers assisted with advance directives resources to provide members?
• What tools does the plan provide to facilitate consumer input into treatment options?
• How are members provided with information on advance directives?
• How is this information incorporated into the plan of care?
• Where in the enrollee (outpatient) record are providers required to document advance directives?

On-site document review will include an examination of the provider manual, materials concerning advance directives, and applicable member education materials.