The Basics

This standard requires that the case manager, using the findings of the assessment, develop a case management plan in collaboration with the consumer, members of the health care team and, if needed, experts.  In addition, the case manager should periodically update that plan should the consumer's situation or needs change. 

At a minimum, the plan must set both short- and long-term goals, identify interventions to be implemented and resources to be used in achieving those goals, create time frames for reevaluation and follow-up, and a provide description of how ongoing collaboration among the case manager, consumer, family, and providers will occur throughout the case management relationship.

Management Tips

Make sure the all elements of the plan -- and particularly the goals within the plan -- are individualized to each consumer.  The best way to assure individualization is through clear P&Ps and tools and training that link the plan development closely to the results of the CM assessment.  

What happens when a provider delegates his/her role in the collaboration to someone else?  So long as the organization documents that it made an effort to involve the provider, it will have fulfilled the intent of this standard.

URAC Accreditation Tips

All the elements of this standard carry a weight of "4".  

Documentation required is a combination of the P&P describing the CM plan development process and documentation of implementation of that P&P, including plan forms, screen shots of electronic plan forms, and the like. 

The onsite review, again, will focus on interviews with the case managers about how they go about designing an individualized CM plan, as well as a review of individual CM case files to assure that a plan is developed for each consumer in the program.