Note: Effective January 1, 2006, The Joint Commission discontinued its Network Accreditation Program for Managed Care Organizations. However, The Joint Commission will continue to provide a full array of support services and oversight to organizations accredited under this program through the end of each organization’s respective accreditation award period.
The Joint Commission has been accrediting Managed Care Organizations for more than 10 years. The Joint Commission accredits network organizations throughout the United States, including MCOs, managed behavioral health care organizations, integrated delivery systems, and preferred provider organizations. To be eligible for a Joint Commission accreditation survey, a MCO must have the following characteristics:
- Provides health care services to a defined population of individuals.
- Offers comprehensive and/or specialty services.
- Both a centralized integrating structure and contracts with, or manages, actual care delivery sites, which include practitioner offices and/or components that deliver care.
Standards
MCO standards, published in the 2005-2006 Comprehensive Accreditation Manual for Managed Care Organizations, specifically address issues related to organization-wide integration, coordination and accountability that are vital to health care organizations. The standards cover:
- Rights, Responsibilities and Ethics
- Continuum of Care
- Education and Communication
- Health Promotion and Disease Prevention
- Improving Performance
- Leadership
- Management of Human Resources (including Credentialing)
- Management of Information
- Utilization Management
The survey process
The survey of a MCO's performance includes:
- Evaluation of the principal administrative location that manages the MCO.
- Interviewing leadership, staff and other stakeholders.
- Reviewing documents.
- Offering insight to help the MCO improve its compliance with the standards.
For more information, visit www.jointcommission.org or call (630) 792-5291.
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