COA - Council On Accreditation

	Network Administration

Introduction

Administration and Management

Service Delivery Administration Standards

Service Standards

Administration and Management Narrative (NET):

The Administration and Management Narrative should provide an overview of key practices that contribute to the performance and productivity of your organization. The Narrative supports, but should not duplicate, evidence provided elsewhere in your self-study.

The Network Administration, Administration and Management Narrative should provide the Peer Review Team with a clear, concise description of how your network administration practices contribute to the effective management and coordination of an integrated network of service providers.

Purpose Standard: Network Administration (NET)

Network services are delivered to a defined population through an integrated network of providers with the goal of ensuring optimal access, quality of care, and consumer satisfaction.

Provide responses to the following questions that address your organization’s achievement of the Network Administration Purpose Standard. Highlight applicable obstacles and innovations, if any, in each of your responses.

1. Provide an overview of your network's structure. Include:

Why was your network formed?
How is it governed?
Scope of services and how services are deliveredd. Relationship with provider organizations, contractors, network partners, owners, member agencies, cooperatives, lead agency, etc.

2. How are the network's services funded?

3. Describe how your organization manages communication with providers throughout the network.

4. Describe the scope of the network's utilization management activities.

(e.g., does utilization management include authorization that is external to the provider? Is it limited to establishing criteria, reporting utilization data, and retrospective reviews?)

5. How does the network/lead agency monitor the quality of its services network-wide?

6. Provide any additional information that would be useful to the Peer Team.

Attachments:

Updated list of contractors with contact information, services provided to the network, accredited or not, and if so by whom.
Network Organization chart.
Completed Network Standards Matrix.
All COA-approved NA Requests.
A list of all NAs applicable to your organization provided within the standards.

Note:

Networks being accredited for the first time: Please provide information for the last two years.

Networks being reaccredited: Please provide information for the period since the last accreditation review.


	Self-Study Documents	On-Site Documents	On-Site Activities
NET 1 Network Characteristics	Mission Statement Articles of Incorporation/Bylaws List of Governing Body and Advisory Body members and affiliations A narrative describing organizational structure, the scope of services, network partners/owners		Interview: Managing entity CEO Network Advisory/Governing Body Directors of organizations that contract with the managing entity Persons served/community stakeholders
NET 2 Network Organization	Narrative overview of how the network management entity ensures clear communication throughout the network Narrative overview of service delivery system List of network provider organizations and individual providers including the network services they provide Grievance/complaint procedures for network service providers		Interview: Managing entity CEO Network Advisory/Governing Body Directors of organizations that contract with the managing entity Independent practitioners Persons served/community stakeholders
NET 3 Planning	Long-term and annual plans Planning procedures Network-level workforce analysis and documentation of actions taken		Interview: Managing entity CEO Network Advisory/Governing Body Directors of organizations that contract with the managing entity HR manager for the managing entity and representative network provider organizations
NET 4 Network Services	Service coordination procedures Admissions procedures/criteria Eligibility criteria Level of care procedures		Interview: Network CEO/Commissioner/Executive Management Provider Clinical Management/Supervisors, and Independent practitioners Community Stakeholders Persons served
NET 5 Access to Network Services	Access procedures and guidelines Triage and critical care criteria		Interview: Clinical Management/Supervisors Provider Clinical Management/Supervisors, and Independent practitioners Community Stakeholders Persons served Review Client records Utilization management data/reports
NET 6 Screening and Intake	Screening procedures		Interview: Clinical Management/Supervisors Provider Clinical Management/Supervisors, and Independent practitioners Community Stakeholders Persons served Review: Client records Utilization management data/reports
NET 7 Utilization Management	A description of the scope of utilization management activities (For example, does utilization management include authorization? Is it limited to establishing criteira, reporting utilization data, and retrospective reviews?) Utilization management procedures, including: Criteria for placement decisions Processes of approving the criteria and making the criteria available to those applying the criteria Authorizing services Appeals, and notifications of appeals when requests are denied	Utilization management reports Records of authorization decisions, including the application of the criteria to the decision Records of utilization management reviews at provider locations Evidence of the source of UM criteria	Interview: Care managers Clincial directors at provider organizations Independent practitioners Direct service providers Review: Personnel files of UM personnel
NET 8 Outcomes Measurement	See evidence provided for PQI 3 and PQI 4	See evidence provided for PQI 3 and PQI 4	Interview: Network PQI Coordinator Relevant staff from provider organization Indepedent practitioners
NET 9 Members and Community Partners	See evidence provided for PQI 3 and PQI 4		Interview: Managing entity CEO Network Advisory/Governing Body Directors of organizations that contract with the managing entity Independent practitioners Persons staked/community stakeholders
NET 10 Network Application Process	Network application procedures Network application(s)	Records of on-site visits and reviews of the specific applications, including the reasons for approving or not approving applications	Interview: Program director CEO/Commissioner/Exectutive Management Providers Contract Management

Fundamental Practice Standards:


Essential Life and Safety	Health and Welfare	Client Rights

RELATED FILES


	SERVICE One or more organization-operated programs or activities that have a common general objective and deploy the organization's material and human resources in a planned and systematic manner. An organization that publicly promotes or identifies itself in writing as offering a service, is licensed to deliver a service, assigns personnel and/or space to a service, or allocates financial resources to a service is considered to offer that service.


	QUALITY In this context, the extent to which contemporary and generally recognized standards for professional practice are met and exceeded, and desirable service outcomes achieved.


	CONSUMER The individual, family, group, or community that seeks or receives services.


	ADMINISTRATION The personnel responsible for management functions of the organization, including fiscal management, human resources, and service delivery. Such personnel determine organizational goals, acquire and allocate resources to carry out a program, coordinate activities toward goal achievement, and monitor, evaluate, and make needed changes in processes and procedures to improve the likelihood of goal achievement. The term is synonymously used with MANAGEMENT.


	PRACTICE Established actions or ways of proceeding in the regular performance of organizational duties. Policies and procedures often guide practice.


	PERFORMANCE A measure of how well an organizational system provides services to consumers. Performance is often based on key indicators, such as rates of service, cost per consumer, degree of satisfaction with services, and extent of consumer access to services.


	PEER REVIEW An evaluation process in which professionals from similar backgrounds review the work of their associates.


	CRITERIA Systematically developed, objective, and quantifiable statements used to assess the appropriateness of specific decisions, services, and outcomes.


	ACCREDITATION The formal evaluation of an organization against accepted criteria or standards. A professional society, non-governmental organization, or a governmental agency may conduct accreditation activities. A COA-accredited organization has undergone a period of rigorous self-study and is capable of providing programs and services that meet or exceed COA standards.


	BYLAWS The operating procedures developed by the governing body and adopted by the organization for the regulation of its internal affairs, including the actions of the governing body and its relationship to the chief executive officer and any advisory board associated with the organization.


	MANAGEMENT See ADMINISTRATION


	CONTRACT A formal written agreement between two or more parties that specifies the services, space, or products to be provided in exchange for some form of compensation. Also known as "purchase of service arrangement."


	COMMUNITY A specific group of people living in the same locality and who may share a common culture, values, and norms. Communities can also be defined by race, religion, ethnicity, age, occupation, political status, tribal affiliation, interest in particular problems or outcomes, or other common bonds. The term "community" encompasses worksites, schools, tribes, residential neighborhoods, business districts, recreational areas, and health and human service sites.


	STAKEHOLDER Any person, group, or organization that has a vested interest in the services provided by the organization. Examples: clients, consumers, personnel, funding organizations, referral organizations, vendors, and governmental bodies.


	GOVERNING BODY A person or persons with the legal authority and responsibility to set policy and oversee the operations of an organization. Generally, the governing body is a group, such as a board of directors or board of trustees. While the exact responsibilities of the governing body depend on the nature and character of the organization, the governing body has minimum fiduciary responsibilities to the organization set by statute, regulation, and case law, and typically assume responsibilities for long term planning, risk management, and evaluation and effectiveness of management.


	COMPLAINT An expression of verbal or written dissatisfaction that can include, but is not limited to, services, manner of treatment, outcomes, or experiences. For employees or volunteers, dissatisfaction can include personnel matters such as supervision, evaluations, promotions or demotions, the work environment, and overall treatment. The term is synonymously used with GRIEVANCE.


	PLANNING The process of specifying objectives, evaluating the means for their achievement, and exercising deliberate decision making about appropriate courses of action.


	ELIGIBILITY The degree to which an individual, family, group, or community meets the specific criteria and qualifications required to receive goods, benefits, or services.


	CLINICAL The study, assessment, and diagnosis of the client situation followed by direct treatment to help the client achieve prescribed goals.


	PERSONNEL The body of employees and/or volunteers that carries out the organization's tasks under the organization's administration and/or supervision. This definition does not include foster parents who are specifically referenced in relevant standards


	PROGRAM A system of services offered by an organization. For example, an organization providing a mental health service may offer several mental health programs to different populations, e.g., a mental health program for adolescent teens. The word "program" can be used interchangeably with the word "service" or to describe specific programs.