The Basics

This standard applies to all delegation arrangements, even to those with organizations that are accredited by URAC.  It lists eight specific requirements for the contract between your organization and all delegates.  Some of the requirements are perfunctory (e.g., that the contract describes which duties are being delegated and which duties are being retained by your organization), but there are several elements that you should not assume are already in all of your delegation agreements, particularly if you are a first-time applicant.  Two of those elements are mandatory and almost certainly are not in the delegation agreements of a first-time applicant.

Here are the particularly critical elements of the delegation agreement:

• a requirement that the contractor performed a delegated functions in compliance with your organization's policies and procedures and URAC standards;
• an affirmative requirement on your contractor that it notify your organization of any material change in its performance of the delegated functions;
• authorization for your organization to conduct surveys of the contractor;
• an affirmative requirement on the contractor to submit periodic reports to your organization regarding its performance of delegate function;
• a description of the circumstances under which the contractor may further delegate the functions your organization has delegated to it; and
• a requirement that, if the contractor does further delegate the delegated functions to a subcontractor, the agreement between the contractor and subcontractor specify that the subcontractor will perform the delegated functions under the terms of the delegation agreement between your organization and the contractor and URAC standards.

Of critical importance is that the language in your contract specifically mention URAC in both of the contexts described above.  Merely referring to "accreditation standards" will not suffice (although at one time such language would have been enough).

Management Tips

A sticking point for many applicants, delegation contracts require more attention than most aspects of a URAC accreditation application. 

A few things to remember:

If your delegate is URAC-accredited, this is the only standard that applies to that delegation relationship.

Subsection (b) is explicit about the agreement requiring that the delegate comply with URAC standards. A clause requiring the delegate to comply with your organization's standards (which, of course, comply with URAC standards) is not enough. Similarly, a clause requiring that the delegate comply with another accreditor's standards (e.g., NCQA) is not enough. 

Subsection (c) is another tricky one. Put simply, your contract must have a clause which confers an affirmative obligation on your delegate to let you know when circumstances have changed such that it can no longer perform the functions it's supposed to perform under the agreement. This is separate from the reporting obligation under subsection (e). Be explicit about this requirement on your delegate.

Subsections (g) and (h) are distinct requirements. Restated, (g) requires that your agreement describes what the delegate must do in order to subdelegate (e.g., get your permission in writing). If your agreement prohibits subdelegation, that will suffice. Subsection (h) is applicable only if subdelegation is permitted, and requires that your delegation agreement require that any subdelegation arrangement be subject not only to your organizational requirements but also to URAC's (or "applicable accreditation requirements").

URAC Accreditation Tips

The two elements that specifically reference URAC are both mandatory. The rest range in value between 2 and 4.

While URAC only requires that you submit your template delegation agreement, we also recommend that you submit a policy and procedure that requires that all delegation agreements comply with the standard.

During the on-site review, again, the reviewer's attention will be on the delegation binders.