Core

One of the new features of the scoring methodology in v. 3.0 is that Core will always be 30% of of the total points available for accreditation, regardless of the accreditation program.  This is a change from previous versions, when the percentage of total points allotted to Core depended upon the program.  For example, previously, Core was a smaller factor for Health Plans than it was for a single module program, such as Utilization Management or Independent Review Organization.

One of the changes in v. 3.0 has to do with policies applicants are expected to submit with their application. 

Previously, what was requried to be submitted to document compliance with standards was "policies and procedures."  URAC has changed this to allow for "written policies and/or documented procedures." 

The purpose of this change is to distinguish between policies, which provide direction and guide decision-making from procedures, which map out the steps for staff to follow to perform a particular function.  "Procedures" could include a process flowchart, escalation matrix, guidelines, etc.

URAC is starting to clarify its new Core standards, v. 3.0, which will be known as "Module I" for all the healthcare accreditation programs.  The new standards have a release date of November 2008, and were the subject of extensive interest at the 2008 URAC Summit.

Core 1-23 and 25-29 apply to all applicant organizations regardles of the accreditation program.  On the other hand, Core 30-35 apply only when clinical staff is required to perform the function covered by the accreditation.  The programs in this category are:

• Health UM
• Workers Compensation UM
• Independent Review Organization
• Provider Credentialing
• Claims Processing
• Credentials Verification Organization

Core 24 and 36-40 apply when clinical staff interface with consumers.  This includes:

• Case Management
• Disease Management
• Health Call Center
• Health Plan
• Health Network
• Consumer Education and Support

Core 13 (c) provides:

The organization implements information system(s) (electronic, paper or both) to collect, maintain, and analyze information necessary for organizational management that:
* * *
(c) Includes a disaster recovery plan that;
(i) Is tested at least every two years; and
(ii) Addresses identified areas for improvement; . . ..

Cartoonist Scott Adams, creator of Dilbert, provides a vivid example of what URAC will not accept for this standard.  Click here, and then the "play" arrow over the picture, to view the 23 second clip.

This standard may be the shortest ever:

Staff meets qualifications as outlined in written job descriptions. (Primary)

It carries a weight of 3, and, like Core 4, has a straightforward documentation requirement at the AccreditNet phase of the process: submit job descriptions.  You may (and should) submit the same documents you submitted for Core 4.

The difference here with Core 4 is in the onsite review: for the staff members selected from the employee directory, the reviewer will compare the job descriptions' requirements to the résumés of the respective employees to make sure that they meet the requirements as outlined in the job descriptions.  The personnel file audit we recommend in our lengthier blog on the topic (click here) should include a check for that concurrence between job descriptions and résumés.

This standard provides:

The organization has written job descriptions for staff that address: (Primary)
(a) Required education, training, and/or professional experience; (Secondary)
(b) Expected professional competencies; (Secondary)
(c) Appropriate licensure/certification requirements; and (Primary)
(d) Scope of role and responsibilities. (Secondary)

It carries a weight of only 2, indicating how distant job descriptions are from consumer protection in URAC's mind.  

The documentary requirements for this standard are straightforward -- submit up to 9 job descriptions of the staff members who do the bulk of the work in the areas that are the subject of the accreditation module(s).  The onsite review is, as you might expect, a random selection of actual job descriptions, chosen from the staff directory. 

This standard typically is missed onsite by organizations that have not set minimum requirements for non-clinical staff members.  Therefore, we recommend a complete internal audit, particularly by the HR departments of first-time applicants, of all the job descriptions to assure that they all (clinical and non-clinical) have minimum requirements.  

One other tip -- eliminate the words "or equivalent experience."  They are, in URAC's view (and mine), meaningless.  Describe what that equivalent experience might be, and you'll be fine. 

In late 2007, URAC made slight modifications in its Core standards.  We reported all of them here.  Two of the changes involved consolidating standards: Core 22 was attached to Core 21, and Core 36 was attached to Core 35. 

The consequence for this blog is that all our posts about standards numbered higher than Core 22 are, for some of our readers (those currently going through the early stages of the accreditation process) were rendered incorrect.  For example, a post I wrote last year about Core 24, the Consumer Safety Mechanism standard, was, until I fixed it yesterday, misnumbered.  

We're going through all the posts to make sure they get numbered correctly, but please be patient as we go through this process.  Also, if you are working from a slightly out-of-date version of the standards, you'll think these newly numbered standards are wrong.  

This mandatory standard provides 

Core 25 – Access to and Monitoring of Services
The organization:
(a) Establishes standards to assure that consumers or clients have access to services: and (Primary)
(b) Defines and monitors its performance with respect to the access standards. (Primary)
Note what URAC says in the first bullet of the Interpretive Information (at least in some versions):  "Core 25 does not refer only to network adequacy. It refers to any services that the organization provides." 

So, if you are applying for Health Plan or Health Network accreditation, be sure you submit some sort of access documentation in addition to the network adequacy you'll be submitting under the applicable Network Management standards.  Telephone statistics are a good "go-to" for nearly all URAC applicants under this standard.   URAC explains: "Many programs use telephone statistics to measure access to program services.  After establishing acceptable standards, measurements are periodically taken to ensure consumer and client access to services. Access standards related to telephone services should include standards regarding returning or responding to after hours calls and/or voice messages."
 

At a recent URAC educational program, the URAC reviewer giving the presentation made it clear that this policy, which requires the organization to ensure that consumer healthcare is not compromised whenever there is compensation based on consumer utilization, includes capitation of providers.  Not all URAC reviewers over the years have interpreted this standard this way, so it is helpful to get official clarification on this sometimes controversial issue.

This becomes more critical now that the 2007 changes are moving into effect this summer: this standard is now a mandatory standard.  Mess it up and there's no Full Accreditation for your organization! 

The proposed change in Core 14 is barely perceptible, even to the trained eye.  The new standard would read:

Core 14 – Written Business Agreements
The organization maintains signed written agreements with all clients describing the scope of the business arrangement. (Wt=2)

The scoring weight's the same, the language is the same --  then what is it?

Ah, there it is!  The title would change.  The current standard is called "Business Relationships."  This simply makes the title of the standard more closely depict the content of the standard -- a requirement that applicants have contracts with their clients.