Update: September 14, 2016 (comment period extended & detailed crosswalk added)

RE: 2nd Public Comment – URAC Core Accreditation Standards, Version 4.0

Dear Colleague:

URAC is pleased to present draft revisions to its Core Accreditation standards. The Core standards are designed to interlock with program-specific standards in URAC accreditation programs such as Telehealth, Case Management, and Pharmacy Benefit Management. They are meant to provide a comprehensive assessment of quality and program integrity.

This is the second round of public comment offered for URAC Core Accreditation, Version 4.0. In response to the initial round of feedback, URAC is now making available the full complement of Core v4.0 guide information – including interpretive information and demonstration of compliance requirements. In addition to the table that contains information on applicability, URAC has added a detailed crosswalk between versions 3.0 and 4.0. URAC has also added an Index that lists Core v3.0 and Core v4.0 standard titles and the page numbers where they are located for the following documents: Summary Table, Detailed Crosswalk, and Program Guide.

URAC is committed to having the broadest possible input into its standards development process. We strive to ensure that our accreditation is meaningful across the health care spectrum – including its effect on consumers, purchasers, providers, regulators, and the industry. Public input is considered to be a very important part of this process. For this reason, we would greatly appreciate any comments you may have on the draft revisions to URAC’s Core standards.

We invite your comments on the proposed revisions until 8:00 p.m. Eastern on Friday, September 30, 2016.

Thank you for being an important part of URAC’s standards revision process. 

Core Standards, Version 4.0
For this major revision, URAC updated its program standards to reflect the evolution of the health care system. Changes ensure key areas covered by the accreditation program remain comprehensive and reflect leading edge industry practices. With these changes, URAC seeks to ensure that accreditation continues to be a mark of distinction for accredited organizations within the health care marketplace.

Highlights of the proposed revisions:

  • The Core standards reflect a new program format. Each section, now called a “focus area,” includes information on “guiding principles” and a rationale. Each standard includes specific and measurable elements of performance along with interpretive information and demonstration of compliance requirements.
  • Focus areas address concepts essential to establishing quality health care organizations capable of monitoring their own performance:
    • Risk Management
    • Consumer Protection and Empowerment
    • Operations and Infrastructure
    • Performance Monitoring and Improvement
  • New standards and their associated elements of performance are added to address health care ethics, leadership, and business ethics.
  • The scoring methodology is modified and will go into effect in 2017 as Core v4.0 is incorporated into the various programs that include Core:
    • Core standards score represents 40% of the total final accreditation score, up from 30% (with the remaining score derived from program-specific standards)
    • Numeric weights assigned to each standard and element of performance are simplified to either 2 or 4 (the weights of 1 and 3 are eliminated)
    • Rather than scoring each standard separately, module scoring is now calculated for all numerically-weighted standards and elements of performance (the scoring calculation at the standard level is eliminated)
    • The minimum final accreditation score required to achieve full accreditation is changed to 95% or above (up from 94%)
  • For every accreditation program that includes Core, URAC excludes standards and elements of performance determined not applicable for that program across the board.

Other changes to standards:

  • Pharmacy Core and IRO Core are replaced with “Core” – where non-applicable standards and elements of performance are excluded based on the individual program.
  • Changes are made to delegation contract language.
  • Consumer-facing organizations are asked to establish a strategic plan to provide culturally and linguistically appropriate services in addition to addressing health literacy.
  • Requirements for business continuity plan testing are clarified.
  • Standards now require organizations to establish criteria guiding the selection and prioritization of corrective action plans and quality improvement projects.

Submitting Comments
The proposed revisions include numeric weights assigned for scoring purposes, along with mandatory requirements and optional leading indicator practices. The full complement of interpretive information in for each group of elements of performance is included in the draft revisions provided below for your reference.

You are welcome to comment on any aspect of the program: focus areas, standards, and elements of performance, which will include interpretive information; this includes any that were not revised. Please send URAC your individual comments through our online form (a link to this form can be found at the bottom of this page).

Public comments will be accepted until 8:00 p.m. Eastern on Friday, September 30, 2016.

The "Reference" documents below are in Adobe PDF format. You must have Acrobat Reader installed on your computer to view them. Click here to download the latest free version of Acrobat Reader.

For more information on this revision to URAC’s Core Accreditation standards, please contact URAC’s Director, Program Standards and Maintenance, Donna Merrick at 202-216-9010 or email Program_Standards_and_Maintenance@urac.onmicrosoft.com.

Index to Standards and Elements.pdf
Core v4.0 Summary Table - Applicability.pdf
Detailed Crosswalk Core v3 x v4.pdf
Focus Area C-RM - Risk Management GUIDE.pdf
Focus Area C-CPE - Consumer Protection and Empowerment GUIDE.pdf
Focus Area C-OPIN - Operations and Infrastructure GUIDE.pdf
Focus Area C-PMI - Performance Monitoring and Improvement GUIDE.pdf
URAC Core v3.0 GUIDE.pdf
Standard PHARM Core 14 GUIDE.pdf
Standards P-QM 6-7 GUIDE.pdf
Standard PHARM Core 41 GUIDE.pdf
Modified Scoring Methodology.pdf
URAC Guiding Principles.pdf