URAC Medicare Advantage Organization Accreditation Consulting — Integral Healthcare Solutions

Last updated: April 2026

IHS is a specialized healthcare accreditation consulting firm with over 25 years of URAC expertise. We guide Medicare Advantage HMOs, PPOs, local preferred provider organizations, and MA-PD plans through URAC Medicare Advantage Organization Accreditation — the CMS-approved deeming pathway that satisfies federal Part C compliance requirements and supports competitive market positioning. Our practice is led by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC.

What Is URAC Medicare Advantage Organization Accreditation?

URAC Medicare Advantage Organization Accreditation is a CMS-approved third-party review program that confers deeming status on Medicare Advantage plans. Deeming means that CMS accepts URAC accreditation as satisfactory evidence of compliance with specific federal regulatory requirements under 42 CFR Part 422 — eliminating the need for separate CMS review of those same elements.

The program covers five core regulatory domains that CMS has authorized URAC to assess:

• Quality Improvement — program structure, performance measurement, and ongoing improvement activities
• Anti-Discrimination — nondiscrimination policies and member access equity
• Confidentiality and Accuracy of Enrollee Records — member data governance, privacy, and security
• Information on Advance Directives — member communications and documentation requirements
• Provider Participation Rules — network adequacy and participation criteria

CMS renewed URAC's deeming authority in 2025 for a six-year term through July 2031, covering Medicare Advantage HMOs and local preferred provider organizations. Accreditation is awarded for a three-year term upon demonstrated compliance with applicable standards.

Who Needs URAC Medicare Advantage Organization Accreditation?

The program is designed for organizations that have contracted — or are preparing to contract — with CMS to deliver Part C benefits. Typical candidates include:

• Medicare Advantage HMOs seeking a streamlined federal compliance pathway and reduced audit exposure
• Local and regional PPOs operating in competitive MA markets where accreditation signals quality to brokers and employer groups
• MA-PD plans with integrated prescription drug coverage requiring coordinated compliance across Part C and Part D requirements
• Special Needs Plans (SNPs) — URAC also offers a Medicare Advantage Organization Accreditation with Special Needs Populations pathway for plans serving dual-eligible, institutionalized, or chronically ill enrollees
• New MA market entrants using accreditation to accelerate regulatory readiness and demonstrate organizational maturity to CMS and state regulators

Organizations that are already accredited under URAC's Health Plan Accreditation or Utilization Management standards may be able to leverage existing compliance infrastructure, reducing the incremental burden of Medicare Advantage accreditation.

The CMS Part C Regulatory Framework

Medicare Advantage plans operate under one of the most demanding compliance regimes in U.S. healthcare. CMS conducts annual program audits — including Compliance Program Effectiveness (CPE) audits, Enrollment and Disenrollment audits, and Special Needs Plan reviews — and has authority to impose intermediate sanctions, civil monetary penalties, and contract termination for material noncompliance.

Key Part C requirements that intersect with URAC accreditation standards include:

• Coverage determination and appeals timeframes under 42 CFR §422.568–422.590
• Quality Improvement program requirements under 42 CFR §422.152
• Network adequacy and provider participation standards under 42 CFR §422.112
• Advance directives communication requirements under 42 CFR §422.128
• Enrollee rights and anti-discrimination protections under 42 CFR §422.110

URAC accreditation satisfies the CMS review obligation for the five deemable domains. Plans retain full responsibility for all non-deemable Part C requirements — URAC accreditation is a compliance accelerant, not a complete compliance substitute.

Two Accreditation Pathways

URAC offers two program configurations for Medicare Advantage plans:

• Medicare Advantage Organization Accreditation (standard) — covers the five CMS-deemable domains for HMOs and local PPOs serving the general MA population
• Medicare Advantage Organization Accreditation with Special Needs Populations — adds standards specific to SNP model of care requirements for plans serving dual-eligible (D-SNP), institutionalized (I-SNP), or chronically ill (C-SNP) enrollees

The standard pathway is a standalone accreditation — it does not require concurrent enrollment in any other URAC health plan accreditation program. Organizations with existing URAC accreditation may find substantial overlap in their compliance documentation, particularly in Quality Improvement and Risk Management standards.

The Accreditation Process

URAC markets Medicare Advantage Organization Accreditation as completable in ten months or less through a collaborative, non-prescriptive process. URAC does not mandate specific policies or procedures — plans have flexibility in how they demonstrate compliance, which rewards organizations with sophisticated program infrastructure and penalizes those attempting to paper over operational gaps.

The IHS engagement follows a structured sequence:

1. Gap Analysis and Standards Review — comprehensive mapping of current operations against all applicable URAC standards, identifying compliance gaps, partial-credit opportunities, and documentation deficiencies
2. Policy and Program Architecture — development or revision of policies, procedures, committee structures, and reporting mechanisms to close identified gaps
3. Evidence Compilation — assembly of supporting documentation, audit trails, and performance data aligned with URAC submission requirements
4. Mock Survey — internal validation against URAC review methodology before formal submission, identifying any remaining exposure
5. AccreditNet Submission Management — preparation and submission of the formal application through URAC's AccreditNet portal with complete supporting materials
6. Review Support and RFI Response — if URAC issues a Request for Information (RFI) during review, IHS drafts the response and manages the dialogue with the URAC review team
7. Ongoing Maintenance — post-accreditation support for annual reporting, policy maintenance, and preparation for three-year renewal

Why IHS for URAC Medicare Advantage Accreditation

IHS is led by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC. That background means our team has direct insight into how URAC standards are written, interpreted, and applied during review — knowledge that no outside observer can replicate from published documents alone.

• Insider standard interpretation. We understand the intent behind each standard, not just the text — including how reviewers assess edge cases and borderline documentation.
• Regulatory integration. We connect URAC standards to the underlying CMS regulatory citations, helping your compliance team understand exactly which Part C obligations each accredited domain satisfies — and which it does not.
• Non-prescriptive by design. We build compliance programs that fit your operational model, not generic policy templates that create new exposure by documenting practices you cannot sustain.
• RFI expertise. Most accreditation delays occur at the RFI stage. Our response drafting draws directly on knowledge of what URAC reviewers are actually looking for when they ask follow-up questions.
• Three practice lines. IHS serves MA plans across accreditation consulting, compliance services, and program development — we can address gaps in your broader Part C compliance program, not just the five deemable domains.

Performance Measurement Compatibility

URAC's Medicare Advantage standards are designed to be compatible with existing MA plan reporting requirements. Organizations that are already producing CAHPS® survey data, HEDIS® quality measures, Health Outcomes Survey (HOS) results, and CMS Star Ratings documentation will find significant alignment between those reporting obligations and the Quality Improvement evidence URAC requires.

IHS can map your existing performance measurement infrastructure against URAC's evidence requirements, identifying which data you already produce and where new collection mechanisms are needed — avoiding duplication of measurement effort.

Schedule a Consultation

If your organization is preparing to pursue URAC Medicare Advantage Organization Accreditation — or is already in process and encountering obstacles — contact IHS for a direct conversation with Thomas G. Goddard, JD, PhD.

Engagements are scoped per client situation. There is no standard fee schedule.