The Basics

CM 11 requires that you implement your organization's P&Ps dealing with consumer rights, informed consumer choice, consumer input into CM plans, right to refuse treatment, end of life and advance care directives, criteria for case closure, notification rights for CM case change or termination alternatives available when the consumer or his/her family cannot adequately participate in CM care.  So, staff members need to know how to find those P&Ps and what they require.  Staff members also need to be clear on their organization's specific requirements on how to document that consumers are aware of the rights covered by this standard.

Management Tips

Management's first job regarding CM 11 is to make sure that the organization's relevant P&Ps cover all eight topics that URAC requires to be covered by the CMO's P&Ps promoting consumers' autonomy and decision-making.  The topics include:

• consumers' rights
• informed consumer choice
• consumer input into CM plans
• right to refuse treatment
• end of life and advance care directives
• criteria for case closure
• notification rights for CM case change or termination
• alternatives available when the consumer or his/her family cannot adequately participate in CM care

If your CM program model provides for verbal delivery of this list of consumer rights, make sure you have a mechanism that documents, in every case, the giving of such rights to the consumer.  An initial checklist is a good approach to this documentary requirement.

URAC Accreditation Tips

The easiest (and most common) approach to documenting this is to develop a consumer rights document, post it on the organization's Web site and deliver the document to CM program participants early in the relationship.  In addition, the organization should have a P&P that specifies mechanisms for getting this information into the hands of consumers. 

The onsite review will combine interviews with and observations of case managers with the review of randomly-selected CM files.

All eight requirements are primary elements of this standard, which carries a weight of 4.