Our moms always told us if we spent too much time watching TV it would fry our brain. If you’ve spent any time watching the political news the past few months you’d probably agree.
Despite what you may see on the airwaves, 2018 has been pretty good for government action impacting URAC.
Here is a summary of URAC’s government “wins” to date:
- CMS continues to rely on URAC and other accreditors to determine the network adequacy of Qualified Health Plans (QHPs) in states that do not have active oversight of provider networks in commercial insurance. Read more on how URAC supports the establishment of adequate networks here.
- CMS chose not to take action to limit the role of accreditation in the pharmacy networks utilized by Medicare Advantage plans (Parts C and D). URAC’s Specialty Pharmacy Accreditation is widely used by Medicare Advantage plans as a tool for quality assurance among their specialty pharmacy networks. This is similar to the use of Specialty Pharmacy Accreditation in commercial insurance markets. Read Aaron’s blog article on URAC’s public comment about this here.
- The State of Nevada Public Employee Benefits Program received URAC Core Accreditation. This marks the first time a state public employee benefit program has pursued and achieved accreditation. This represents a new market for URAC to target and if you’re a fan of good government – a positive sign that at least one agency is willing to compare their quality standards broadly accept in the commercial sector. Read the press release here.
- I want to make sure to recognize the considerable work done by Ashley Adamik, Diane Sacco, and Karen Watts. Since Nevada is not a commercial enterprise, we were required to be flexible in our normal process to accommodate the unique nature of state agencies. Nevada’s success would not have been possible without the work of Ashley, Diane, and Karen!
- The Indiana General Assembly enacted SB 369 which requires employers to send all workers’ compensation non-preferred drug related appeals to a utilization review agents (URAs) that is URAC accredited. This represents a new deemed status for URAC.
- URAC worked with the Alaska Department of Insurance to provide a crosswalk of URAC’s IRO standards compared to the state’s external review regulations. This marks the 42nd state to utilize URAC IRO accreditation in their oversight of the external review process.
- Brittany would like to recognize the work and guidance of Deborah Smith in helping with this effort (and many others in Aaron’s absence)
- The final win is government in nature but is actually a result of and a testament to the work Allison King put into the Telemed Leadership Forum. The Executive Director of the VA’s telehealth program, Dr. Kevin Galpin, spoke at URAC’s Telemed Leadership Forum. As a follow-up to his presentation, he met with Kylanne to continue the dialogue regarding quality in telehealth and the future of the VA’s services. While no accreditation was sold, this connection and our continued relationship is a positive development that I believe was a result of Dr. Galpin’s positive experience with URAC.
As always, if you have any questions or want to discuss anything please do not hesitate to reach out!
