The Basics

Under this standard, you need to be familiar with your organization's P&P that describes the criteria you should use to decide whether and when to discharge a consumer from the program.  You should not only know your organization's P&P on the topic, but somewhere along the way should have received training on that P&P.  Finally, make sure you always document both the date of the discharge/termination and the rationale for that action.  

Management Tips

This standard requires the CM Program to do the following things:

• Write a P&P that describes -- clearly -- what criteria it uses to decide when and whether to discharge a consumer from the program, or terminate CM services to that consumer.
• Train the CM program's staff members on these criteria.
• Upon discharge or termination, record both the date of the discharge/termination and the rationale for that action.  The CM program should make sure that the documented rationale is consistent with the criteria outlined in the P&P.

As the program guide makes clear, URAC has expectations about this standard that are not embodied in the standard itself.  To meet those expectations:

• Make sure that the consumer is advised of the criteria early in his/her relationship with the case manager.  In other words, it should come as no surprise to the consumer that, when he/she meets her care goal, or returns to work, or in some other ways triggers the discharge criteria, that his/her relationship with the CM program will be ended.
• Notify all the providers of the discharge/termination.  The consumer's transition out of the CM program should be clinically smooth and safe.

As is always the case with URAC, it is not enough that you do these things, but also that you describe and require them in your P&P.

What if your clients set the criteria for discharge?  This is not uncommon, and it usually happens in the contract itself.  In this case, make sure your P&P allows for the possibility that the criteria in the P&P may be overridden by the policy established in the contract by the client.

URAC Accreditation Tips

The desktop review will focus on the adequacy of the P&P.  Further, if your clients do set the criteria, list the clients that do so and summarize the discharge criteria for each in a table that you submit to URAC.

The onsite review will focus, as usual, on interviews.  However, more importantly, the reviewer, as a part of her examination of case files, will check to make sure that the discharge criteria have been followed with your consumers.