The Basics

Under CM 19, the CM program must implement a P&P that requires case managers to obtain and document consumers' oral or written consent to participate in the CM program.  The P&P also should specify a time frame within which that consent should be obtained and the duration of the consent's validity.

Note to workers' compensation CM organizations:  Because many state WC laws assume consent, this is optional for WC CM programs.  

Management Tips

The P&P should define both a time frame for obtaining the consent and a length of time for which the consent is valid.  Additionally, if the P&P does limit the duration of the consent, it also should provide for a process under which the consumer may renew his/her consent.

This standard is not so harsh as to require consent in all cases.  It is rigorous, however, in requiring that, if the program does not obtain consent, that it has done this under an exception that it outlines in its P&P on consent.  

The P&P also should provide for consent from family members or other surrogates for the consumer if the consumer is unable to give the consent because of extenuating circumstances.  

URAC Accreditation Tips

The requirement for obtaining and documenting consent is mandatory; the other two elements are worth 4 points each.

Documentation, in addition to the P&P, should include a written consumer consent form and any education/disclosure information provided to consumers that reference consent.  

The onsite reviewer will verify compliance with this standard through her review of the case files. Therefore, it is imperative that the CM program's case files contain clear documentation of written and verbal consent obtained from each consumer, as well as any attempts to obtain written consent.