CMS Renews URAC’s Medicare Advantage Deeming Authority for Six More Years

Pen and stethoscope on Medicare enrollment form

URAC Revises Medicare Advantage Accreditation Program as a Stand-Alone Program

WASHINGTON - May 21, 2019 - CMS has renewed URAC’s status as an approved accreditor for Medicare Advantage (MA) plans, granting URAC “deeming authority” for a new six-year term, through June 2, 2025.

This means that MA plans that meet URAC’s standards are recognized by CMS as being in compliance with federal regulatory requirements related to their Part C coverage. Those that achieve URAC’s Medicare Advantage Accreditation are considered by CMS to have met requirements for:

  • Quality improvement
  • Antidiscrimination
  • Confidentiality and accuracy of enrollee records
  • Information on advance directives
  • Provider participation rules

Medicare Advantage has been increasing in popularity. More than one third of Medicare beneficiaries are now enrolled in Medicare Advantage plans. By some estimates, Medicare Advantage plans will capture 42 percent of the Medicare market by 2028.

With a 3.4 percent increase in federal payments in 2019, Medicare Advantage plans are becoming an even more lucrative market. But for many health plans, the prospect of additional burdens associated with regulatory compliance, including punitive audits by CMS, can be a barrier to entering this market. Plus, newer MA plans face the extra challenge of competing against four- and five-star plans for a share of the market.

URAC’s new Medicare Advantage Accreditation program is a stand-alone accreditation – health plan accreditation is not a requirement to apply for MA accreditation with URAC. The accreditation process has been streamlined to shorten the timeline and effort needed to achieve URAC Medicare Advantage Accreditation. The advantages for MA organizations seeking URAC accreditation are: a simplified accreditation process, focused standards, reduced compliance burden and affordable pricing.

“A Medicare Advantage plan faces a unique regulatory environment that is tailored to address the specific needs of Medicare beneficiaries. URAC’s Medicare Advantage Accreditation is uniquely designed to meet the specific regulatory and population requirements that govern Medicare,” said Aaron Turner-Phifer, Vice President of Government Relations. “Given the significant difference in the regulatory environment governing Medicare Advantage, URAC offers this focused accreditation program as a separate product that makes accreditation an effective compliance tool for organizations offering these plans.”

“We are delighted to have been granted six more years as a 'deeming authority' for Medicare Advantage,” said Shawn Griffin, M.D., president and CEO of URAC. “Our revised Medicare Advantage Accreditation offers a unique cost-effective, time-sensitive way for organizations to meet some of the regulatory requirements to serve this growing population. This program builds upon our almost 30-year history of independent, non-profit accreditation and complements our suite of programs that improve quality, protect consumers, and improve health outcomes. We believe our revised program will let organizations keep their focus on care, not paperwork.”

 

About URAC
Founded in 1990, URAC is the independent leader in advancing healthcare quality through leadership, accreditation, measurement and innovation. URAC offers a wide range of quality benchmarking programs that reflect the latest changes in healthcare 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 healthcare. For more information, visit urac.org.

 

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