Core for Health Plan 3.2

CORE 2 - Organization Documents

Submited by: Tom Goddard

The Basics

This standard sets forth requirements for the organizations documents to include not only a mission statement, but also a description of the organization framework, the target population, and general structure. These documents no doubt exist somewhere, and it will be up to the URAC Accreditation Team in your organization to make sure they all get into the hands of the URAC reviewer.

Management Tips

The requirement of "organizational framework for the program" is a bit less evident than you might imagine, in our experience. This language has confused clients from time to time. We recommend a program description -- of the type often prepared for prospective clients -- that describes how your organization provides its services to clients and consumers. It might be a marketing piece, or a template proposal, or a regulatory document -- anything that describes how you deliver services.
The element addressing the consumers your organization serve is designed to guide the reviewer as she looks at other standards, such as access and availability of services. The reasoning here is that you cannot deliver services effectively if you don't know to whom you are delivering them. Therefore, the description of your "population served" is likely to be in terms of demographics -- income level, literacy, English fluency, age, etc. But if you are a national or state-wide organization? in that case, submit documentation demonstrating that, and then reference the general demographic characteristics of the nation or the state that you serve.

Accreditation Tips

Desktop Review
Most of the elements of this standard can be documented in your program description. The documentation for the mission statement can be a screenshot of the mission statement from your website or a page from a printed document, internal or external.
The documentation for the element for "organizational oversight and reporting" is a description (narrative, organization charts, or both) of your reporting mechanisms for both staff and committees (most notably, the quality management committee).  
Validation Review
The reviewer will interview management and staff members throughout the review to get an understanding of reporting requirements.
Document Review
The reviewer will verify compliance with this standard throughout his/her review of committee meeting minutes in connection with other standards.
Most of the onsite review verification of this standard is melded with the verification of compliance with other standards, so once you get past the desktop review for Core 2, you are largely in the clear.