Revision

The existing standard in both the Health Plan and Health Network standards reads:

The organization provides written notification to providers of the
determination of the providers’ credentialing application within 60
calendar days of the determination. (Secondary) [Wt = 3]

The new standard reads:

The organization provides written notification to providers of the
determination of the providers’ credentialing application within 10
business days of the determination. [4]

This revision carries two important changes. The substantive change is to reduce the notification requirement deadline from 60 calendar days to 10 business days, slicing about 6 weeks off the process. While most of our clients will meet the new timeline, some applicants will have to tighten up their processes.

The second change is an increase in the weight from 3 to 4. Because this is a single-element standard, however, we believe that it will carry less relative weight in the new system than it does now.

URAC-accredited companies will need to add a client satisfaction assessment mechanism under a proposed new standard.  The new standard would read:

The organization implements a mechanism to collect or obtain information about client satisfaction with services provided by the organization. (Wt = 3).

Oddly, the explanatory note to the revision claims that Core 24 currently applies to client and consumer satisfaction assessment, and that this new standard simply splits the client piece of that off into its own standard.  That simply is not true.  Core 24 applies exclusively to consumer satisfaction, as is evidenced by this explanatory note in the current version of Core: "Core 24 refers to consumer satisfaction information regarding the program. This standard may not be applicable to programs that do not interact with consumers."

So, rather than a mere reorganization, this is a distinctly new requirement, never before required of URAC applicants.  This is not to say I think it's a bad idea -- we at Integral Healthcare Solutions conduct client satisfaction surveys regularly.  I only comment on this to make it crystal clear that this is a new requirement, not a repackaging of an old one.

The scoring for the new standard is a barely significant "3", which, under the new scoring system, is barely noticeable.   

URAC proposes to revise Core 4 to read as follows:

The organization has current, written job descriptions for staff that address requirements pertinent to the scope of the positions’ role and responsibilities: (Wt=2)

(a) Required education, training, and/or professional experience; (Wt = 2)

(b) Expected professional competencies; (Wt = 2)

(c) Appropriate licensure/certification requirements; and (Wt = 2)

(d) Current scope of role and responsibilities. (Wt = 2)

In addition to the scoring changes, there are a couple of substantive changes, both seemingly intended to accomplish the same task, that is, to make sure that the organization is keeping its job descriptions up-to-date:

The stem now contains the new language “current” and “requirements pertinent to the scope of the positions’ role and responsibilities.”  In addition, subsection (d) also has the new word “current”. 

This is a terrific change, in my view.  Too often, both in my years as a URAC reviewer and as a consultant to URAC applicants, I’ve seen job descriptions that have not been changed to keep up with an evolving position.  An old job description that doesn’t describe the position in its current form is a useless job description.  By putting relevant teeth in Core 4, this revision is an acknowledgement that current and previous versions of this job description standard awarded points for job descriptions in name only. 

Thus, while this raises the bar a bit, it does so in an intelligent way.  Well done, URAC!

The proposed 2.1 version of Core 3 reads as follows:

The organization: (--)

(a) Maintains and complies with written policies and procedures that govern core business processes of its operations related to the scope of the accreditation; (Wt = M)

(b) Maintains the ability to produce a master list of all such policies and procedures; (Wt = 2)

(c) Reviews policies and procedures no less than annually and revises as necessary; (Wt = 3)

(d) Includes the following on the master list or on all policies and procedures: (Wt = 2)

(i) Effective dates, review dates, including the date of the most recent revision; and

(ii) Identification of approval authority. 

This proposed revision of Core 3 has two substantive components:

• URAC has made subsection (b) more flexible, by including the phrase “the ability to produce” a master list of P&Ps.  This acknowledges the fact that some organizations keep their P&Ps in electronic form, and don’t have an already-printed master list (but could create one with the push of a button).
• URAC eliminated subsection (e) from this standard, seeing as redundant with an element of Core 8.

So, nothing revolutionary here – just a combination of common sense and good housekeeping.  In my view, any time you can make a standard more reflective of operational reality and get rid of duplication, all in the same breath, you’ve done a good thing.

There is no proposed change to the substance of Core 2:

Organization’s documents address: (---)
(a) Mission statement; (Wt = 2)
(b) Organizational framework for program; (Wt = 2)
(c) The population served; and (Wt = 2)
(d) Organizational oversight and reporting requirements of
the program.(Wt = 2)

The only change is in the scoring: in v. 2.0, the entire standard carried a weight of 3; in this proposed revision, each of the four elements (and not the "stem") will carry a weight of 2.  This significance of this change, and changes like it throughout the proposed revisions, is discussed in greater detail here.  Suffice to say that the proposed revision to this standard magnifies its overall relative value significantly compared to one- or two-element standards.

URAC is proposing no substantive revision to Core 1, which reads (and will continue to read):

The organization has a clearly defined organizational structure outlining direct and indirect oversight responsibility throughout the organization.

The only proposed change is to the weight assigned the standard in URAC's scoring system, to change it from its current weight of 3 to the new weight of 2.

As a single-element standard, this is exactly the sort of standard which will experience the most significant downgrade in importance relative to other standards within the Core module, well beyond the downgrade from "3" to "2".  One can see the change in impact by comparing the proposed new value of Core 1 to the proposed new value of Core 2, discussed in greater detail in another blog.  Because Core 2 has four elements in the proposed v. 2.1, with each element being assigned a weight of "2", the total number of "weight units" for that standard is now 8, compared to Core 1's weight of 2.  In other words.  In v. 2.0, Core 1 was equal in value to Core 2; in v. 2.1, as proposed, Core 1 will be worth one-quarter the value of Core 2.

This is no comment on whether this change is a good or a bad thing -- just that people evaluating the proposed standards should understand that the change in the weights of these standards is the least significant change in scoring system -- a far more significant change is found in the assignment of independent scores to the individual elements of the standards.