The Basics

This short, mandatory standard requires that the case manager conduct (and, of course, document) a case management assessment for each consumer (patient, worker).  This assessment must be thorough, and will serve as the foundation for the Case Management Plan, which is the subject of CM 19. 

Although URAC doesn't specify in the standard itself what must be covered by the assessment, its interpretive materials make it clear that, at a minimum, the assessment should gauge the consumers current health and psychosocial status, his/her medical history and treatment plan, what resources may be necessary for appropriate case management, given the consumer's condition, and any safety issues that the case manager detects.  Other possible issues to include in the assessment might include how knowledgable the consumer is about his/her condition and what education might be required to fill in gaps in that knowledge, as well as any family or cultural issues that might bear upon the development of an appropriate plan.

URAC Accreditation Tips

Documentation should include a P&P describing the required assessment and the use of any tools in that assessment.  Screen shots of any automated assessment tools would be useful for submission to URAC in the desktop review portion of the application.  The onsite review will be a through a review of consumer case files to see evidence of assessment for each consumer, as well as interviews of members of the CM staff to determine their ability to conduct proper assessments.