The following URAC standards support the Medicare Advantage standard dealing with consumer communications, which reads:

The MAO provides information on advance directives, emergency services, and policies on MA plan counseling or referral services that the MAO will not provide due to a “conscience” objection in accordance with CMS requirements.

The Basics

URAC MAP-IAD 1 and 2

This standard requires that your organization maintain P&Ps regarding advance directives, which CMS defines as "written instruction such as a living will or durable power of attorney for health care recognized under state law relating to the provision of health care when the individual is incapacitated."  Those P&Ps apply to all adults receiving medical care through your organization.

URAC MAP-IAD 3

Your organization must provide consumers with written rights under state law regarding their right to make decisions concerning their health care, including the right to refuse treatment and the right to draft advance directives.

URAC MAP-4

This standard requires that your organization provide written information to consumers regarding your P&Ps regarding the above self-determination rights.  That statement, at a minimum, must

• point out the differences between institutional and physician-based conscientious objections;
• make a note of the state law allowing conscientious objection;
• describe which procedures are subject to the conscientious objection; 
• provide advance directive information to the consumer at the time of the enrollment;
• make sure the consumer's medical record indicates clearly whether he/she has executed an advance directive;
• avoid discriminating in terms of care given to consumers who have or have not executed an advance directive;
• ensure compliance with applicable state laws; and
• provide staff training and community education regarding advance directive P&Ps.  

URAC MAP-IAD 5

This standard provides that your organization need not provide care that conflicts with an advance directive.  in addition, you need not implement an advance directive if, "as a matter of conscience," your organization cannot implement an advance directive, so long as state law allows providers or agents of providers to conscientiously object.

URAC MAP-IAD 6

This standard requires your organization to inform consumers that they may file complaints about noncompliance with advance directive requirements with the state survey and certification agencies.

Management Tips

Naturally, you'll need to have fully developed policies and procedures to implement all of the standards.you will need to make sure that those policies comply with subpart I of part 489 of chapter IV of the Code of Federal Regulations.  In addition, take care to standardize your advance directive forms so that you can clearly demonstrate compliance with your own policies and procedures.

URAC Accreditation Tips

 The kinds of documents you want to submit for the desktop review include your evidence of coverage, the summary benefits, your provider directory, or annual notice of change, so long as they support these standards.

The on-site review will involve an interview of the customer service and utilization management staff.  That interview will cover such issues as how staff members handle calls from members who request information on advance directives, with special procedures you have for incapacitated members, how you disseminate information about events and directors to members, and how you handle complaints in this arena.  In addition, the reviewer will explore what mechanisms you have in place to support providers' recording of advance directives.  The reviewer also is likely to ask the medical director whether he/she has had any instance in which an advance directive is not adhered by the provider under the claim of a conscientious objection.  Finally, staff members are likely to be asked to demonstrate how community education and staff training are being handled.

In addition, the following URAC standards support MR02: