Certification of Organizational Management 1.0

C-CPE 2-1: Consumer Rights and Responsibilities

Submited by: Tom Goddard

The Basics

This standard requires your organization to:

  • define consumer rights and responsibilities,
  • notify consumers of those rights and responsibilities, and 
  • use those rights and responsibilities to help shape the organization’s policies and procedures.
At a minimum, those consumer rights and responsibilities include:
  • Confidentiality;
  • Disclosure of information;
  • How to submit complaints and appeals;
  • How to access services; and
  • The right to have consumer preferences considered by the organization.
Note that some of the listed rights may not be applicable to organizations operating within a workers compensation system. The onus is on you, though, to cite the laws and regulations that nullify the right granted by this standard.

Management Tips

These requirements may be met by program specific or enterprise-wide policies. 
The scope of the element on "access to services" is defined by the organization's documented description of the services it provides to consumers. Such documentation may include benefit descriptions, formularies, descriptions of provider coverage for a certain area, and other such documents.

Accreditation Tips

Desktop Review
The minimum documents required for this standard include:
A written description, policy, or workflow of the process for advising consumers of their rights and responsibilities; andA copy of the statement of rights and responsibilities that the organization provides to consumers, either through communications or website. Validation Review
Interviews
The URAC reviewer will discuss the organization's process for notifying consumers of their rights and responsibilities with senior management and those members of the staff who are responsible for that notification.

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