Core for Health Plan 3.2

CORE 38 - Consumer Safety Mechanism

Submited by: Tom Goddard

The Basics

One of the most important of the URAC standards is this one, which requires that the organization have processes to respond quickly to urgent situations that threaten consumers' well-being.
Even though the standard speaks of "a mechanism", the reality is that it requires a system of mechanisms dealing with the full array of urgent situations that are likely to confront the applicant. You can see this intent reflected in the Program Guide under the "Evidence for Desktop Review" section:
Policies and procedures regarding responses to consumer safety address suicide, domestic violence, accessing emergency services for members, addressing significant reportable events, quality of care concerns.
What this means for the average employee is that you need to know what to do in the event you come into possession of information that consumers' health or welfare are threatened. Your organization's P&Ps should provide you with that information -- if not, talk to a supervisor about this issue.
Examples of such urgent situations include:

  • Suicide threats
  • Child abuse
  • Spousal abuse
  • Elder abuse
  • Drug and/or medical device recalls
A particularly important issue -- one that is likely to be raised by a URAC reviewer if he/she should happen to talk to you about this standard -- is what happens when a consumer threatens suicide. Your organization likely has a policy on this topic, so be sure you're familiar with it.

Management Tips

Your P&Ps should address the full array of likely issues. Brainstorm with your colleagues about all the possible emergencies that could arise for consumers, and how your staff members might come into possession of that information.
URAC has a very specific notion of what is required of protocols for handling potentially suicidal callers.
Of course, as I’ve noted above, URAC expects a comprehensive system of mechanisms to respond to a wide variety of urgent situations that threaten consumers. However, it appears that, to the extent a URAC applicant has a specific mechanism regarding suicide, URAC requires that the applicant use national standards regarding handling suicide calls when it develops that policy.
Our source for this is a recent URAC desktop review summary that one of our readers sent us for review. Citing the American Foundation for Suicide Prevention’s publication, Facts About Suicide, as well as publications from Suicide Awareness Voices of Education and the National Quality Forum, the URAC reviewer commented that, “ At a minimum, this policy and process must include the process where any staff member, who has the potential to receive a consumer telephone call, can obtain a real-time assistance from another staff member while NOT hanging up, transferring, or putting on hold the caller.”
However, the tricky part of passing this standard is not so much knowing what to submit with the application, but making sure your staff members know what the basic standards of care for each of these urgent situations is.
The upshot of this is that your staff training should include appropriate responses to urgent situations. The URAC reviewers will pose a series of hypotheticals to your staff members, and will listen carefully to their answers to detect the quality of your training.

Accreditation Tips

Desktop Review
In the application, make sure to submit P&Ps that address the full array of likely issues.
Validation Review
To prepare for the onsite review, make sure everybody on your staff (and we mean everybody) can answer the question, "what kinds of situations might arise in your position in which you learn that consumers are in danger, and what would you do in such circumstances?"

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