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URAC Open Public Comment Period for New Independent Review Organization Standards

Tuesday, September 22nd, 2009

Changes Reflect Provisions in NAIC Model Act

Washington, D.C. September 22, 2009 URAC, a leading health care accreditation and education organization, announced today that the public comment period is now open for proposed changes to its Independent Review Organization (IRO) Standards, Version 4.1. Purchasers, policy makers, consumers, health care management organizations, IROs, and health plans are encouraged to provide their comments on the proposed URAC standards now through November 6, 2009.

URAC is committed to keeping its standards current with changes to regulatory and industry benchmark. The proposed changes to the IRO standards are aligned with new provisions in the Uniform Health Carrier External Review Model Act (the Model Act), which the National Association of Insurance Commissioners (NAIC) adopted in June 2008. The Model Act is designed to provide a national standard and uniform approach for processing, conducting, and making external review determinations. One of the provisions of the Act incorporates accreditation to create a streamlined process for approving Independent Review Organizations.

“Independent Review Organizations (IROs) play an important role in consumer protection. Currently it is IROs and state laws that advocate for consumer protection of insurance coverage and outline how consumers can appeal in cases of denial of payment or service,” said Doug Metz, DC, Chair of URAC’s Health Standards Committee and Executive Vice President and Chief Health Services Officer for American Specialty Health. “By keeping its IRO standards aligned with the industry, URAC strives to provide a fair and impartial review process that benefits both patients and physicians with grievances.”

Since September 14, 2009, three states have enacted legislation comparable to the Model Act. In two of those states, Connecticut and North Carolina, the regulations go into effect on October 1, 2009. In Idaho, the legislation is expected to go into effect on January 1, 2010. Illinois and Tennessee have similar legislation pending, which could pass before the end of the year.

“By providing IROs with accreditation standards, URAC helps ensure that services are free from conflicts of interest. The standards also establish qualifications for physician reviewers and address both medical necessity and experimental treatment issues,” said Gib Smith, Executive Director of the National Association of Independent Review Organizations (NAIRO). “These benchmarks help guide consumers and providers, and ensure that everyone has a voice in the process.”

“Because insurance regulations vary from state to state, there is a clear need for quality standards that would simplify the regulated application process and review requirements for Independent Review Organizations and External Review Organizations across different states,” said Joyce Muller, President and CEO of IMEDECS, a NAIRO member organization. “By setting industry standards and promoting accountability and transparency, NAIC, NAIRO, and URAC all serve as role models and examples of how private organizations can offer leadership to coordinate complex regulations.”

URAC’s proposed new Independent Review Organization accreditation standards are available for review and comment at https://www.urac.org/publiccomment/. The deadline for public comment is November 6, 2009. After public comment, additional revisions will be made. Final standards could be approved by URAC’s Board of Directors as early as December 2009.

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For 25 years, URAC has been the independent leader in promoting health care quality through accreditation, education, and measurement. URAC offers a wide range of quality benchmarking programs that reflect the latest changes in health care and provide a symbol of excellence for organizations to showcase their validated commitment to quality and accountability. URAC’s evidence-based measures and standards are developed through inclusive engagement with a broad range of stakeholders committed to improving the quality of health care.

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