Network Administration Introduction
Purpose
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.Introduction
The types of network organizations that COA accredits include:
- Separately incorporated entities that coordinate and manage care on behalf of a group of cooperating organizations;
- Designated lead agencies or management entities; and
- Groups of providers organized to integrate and coordinate services.
When COA accredits a network LME it is reviewing both the organization’s internal operations and functioning, as well as it’s management of the network as a whole and oversight of the services that are being provided by the contracted organizations.
Many of the network LMEs that COA accredits also provide direct services to persons and families receiving network services and these will be assigned applicable service standards.
NA: The organization is not a network management entity and is not assigned the Network Administration (NET) standards.
Note:COA only accredits the LME. Contracted service providers are not included in COA's network accreditation process and will not be visited during the LME's site visit.
Note:Core administrative practices related to the administration and management of networks are not limited to the Network Administration standards, but are also reflected in each of the Administration and Management and Service Delivery Administration standards sections for Private organizations.
Note: Please see the NET Reference List for the research that informed the development of these standards.
Note:For information about the changes made in the 2020 edition, please see NET Crosswalk.
Network Administration (NET) 1: Network Characteristics
NET 1.01
- separately incorporated entity that coordinates and manages care on behalf of a group of cooperating organizations; or
- designated lead agency or management entity; or
- group of public and/or private providers organized to integrate and coordinate services.
NET 1.02
- defines in writing the scope of services offered;
- establishes a written agreement regarding services to be provided by specific network members, community partners, or practitioners in the network; and
- structures services so it can readily adapt to changes in the service environment and the needs of persons served to achieve desired outcomes.
Network Administration (NET) 2: Network Organization
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NET 2.01
- the unique contributions and different goals that each network participant may bring to the common endeavor can be recognized; and
- the network management entity’s business goals can be reconciled with the members’ ethical and mission-driven interests.
NET 2.02
- a process that ensures ease of entry into a system of highly accessible services;
- agreed upon quality improvement expectations for the network as a system;
- uniform utilization and management protocols; and
- a system for managing information that integrates network operations and network participants’ information, including key costs, performance data, outcome indicators, and member or consumer satisfaction data.
NET 2.03
- provides all parties with the information necessary to operate effectively;
- facilitates clear understanding of mutual expectations for all parties; and
- describes a mechanism for the resolution of conflicts, including conflicts of interest, among member entities and/or community partners.
NET 2.04
- denial or termination of the clinical privileges, including of individual service providers within owner and provider organizations;
- decisions not to contract with providers;
- decisions to abrogate contracts with providers;
- the network management entity’s referral practices; and
- claims payments.
NET 2.05
- includes representatives of relevant community groups, consumers, service providers, advocates, and others with an interest in the success of the network achieving its mission or purpose;
- provides information and feedback about services, outcomes, the perception of the network within the community, and other information that would help the network better serve its defined population and the community; and
- serves in an advisory capacity only and does not assume governing body or management responsibilities.
- establish clear and transparent recruitment and selection guidelines;
- have reasonable expectations about what the group can accomplish within the parameters of its mission and available resources; and
- actively consider and respond to the group's input, feedback, or recommendations.
Network Administration (NET) 3: Planning
NET 3.01
- reviews its mission, values, and strategic direction;
- assesses its strengths and weaknesses;
- establishes measurable goals and objectives that support fulfillment of its mission and mandated responsibilities;
- identifies appropriate strategies for meeting identified goals, including the need to redirect, eliminate, or expand service to respond to changing community demographics and needs;
- allocates resources to support capacity development for the delivery system, as needed;
- addresses changes in the funding environment;
- addresses changes in the regulatory environment; and
- includes the input of service recipients and their families.
NET 3.02
NET 3.03
- the full range of services within the network’s scope and the network’s capacity to meet its responsibilities and goals;
- geographic access to network services, including travel times to locations and proximity to public transportation;
- the demographic makeup of network service providers compared to the demographic makeup of service recipients;
- access to specialty service providers, including culturally relevant service providers; and
- flexible hours of operation that meet the needs and preferences of service recipients.
NET 3.04
- evaluates and identifies the type and number of service providers required to accomplish the network's mission, goals, and objectives; and
- supports the achievement of the network’s long-term goals and objectives.
- HR planning;
- evaluation of training needs;
- budget planning; and
- PQI summary reports.
Network Administration (NET) 4: Network Services
NET 4.01
- are provided with a choice of service providers, to the extent possible given available resources and service requirements; and
- can move readily between programs or levels of care as service needs change or progress is made.
NET 4.02
- current eligibility information is maintained for the entire covered population to minimize administrative barriers to prompt service delivery; and
- case records follow persons served to facilitate maximum benefit and continuity of care.
NET 4.03
- substance use disorders;
- serious and persistent mental illness or serious emotional disturbance;
- substantial developmental and physical disability; and
- severe, chronic family and individual problems with multiple, or interacting causes.
NET 4.04
Network Administration (NET) 5: Access to Network Services
NET 5.01
NET 5.02
- accepts referrals through established access points or another functionally equivalent approach to providing accessible care;
- establishes access guidelines that result in prompt telephone response and low telephone abandonment rates; and
- responds to non-urgent requests for services with an offer of an appointment within a week of the initial call.
NET 5.03
- maintain cost-free telephone accessibility 24 hours-a-day, seven days-a-week;
- provide intake, assessment, and admission or referral 24 hours-a-day, seven days-a-week; and
- have mobile capability and can send practitioners or teams into the home, school, emergency room, or police department for purposes of immediate evaluation and crisis intervention, when necessary.
NET 5.04
- emergency care is available immediately, within six hours or less of an initial call; and
- urgent care is available within 24 to 72 hours of the initial call.
NET 5.05
Network Administration (NET) 6: Screening
NET 6.01
- how well their request matches the network’s services;
- whether they are eligible to receive network services; and
- what services will be available and when.
NET 6.02
- give priority to urgent needs and emergency situations;
- support timely initiation of services; and
- provide for placement on a waiting list or referral to appropriate resources when individuals cannot be served or cannot be served promptly.
Network Administration (NET) 7: Utilization Management
NET 7.01
NET 7.02
NET 7.03
- personnel conducting utilization reviews have appropriate experience and training;
- supervisors of service authorization personnel have appropriate experience and possess relevant credentials;
- medical necessity decisions are made by licensed and qualified clinicians; and
- appeals are reviewed by persons who are licensed or credentialed to provide the service under review.
NET 7.04
NET 7.05
- appropriateness of admissions and authorization decisions, if authorizations are part of network services;
- intake and referral processes;
- service planning and service delivery milestones; and
- intake and discharge data including length of service per event, number of encounters per event, and number of re-admissions, as applicable to the service being provided.
NET 7.06
- a quarterly review of its authorization and placement decisions for all network services that includes a ten percent sample of open and closed cases, including a representative sample of high-risk cases; and
- at least annually, a review of ten percent of contractor case records.
NET 7.07
- respond to requests for authorization, initial screening, or reauthorization according to standards for timeliness that are in proportion to the urgency of the request;
- provide a 24-hour response line when responsible for authorization of crisis, emergency, or urgent care; and
- record the reason for placement decisions and relate this decision to criteria.
NET 7.08
- informs the person or service provider requesting the authorization of the reason for the denial;
- relates the reason for the denial to the criteria used for making authorization decisions; and
- informs the person or service provider of the right to appeal the denial of authorization and the timeframes for the appeal.
NET 7.09
- ensure that appeals are reviewed and the results communicated in time for the service recipient to enter or continue services without interruption; and
- vary according to the urgency of the issue.
Network Administration (NET) 8: Outcomes Measurement
- access to care, such as the average lengths of time between initial call and initial screening assessment and the average lengths of time between initial screening assessment and admission to treatment;
- coordination of care, such as the percentage of persons discharged from an inpatient or residential level of treatment who attend a session at their next level of care within a defined period of time (e.g. seven days or fourteen days) from leaving the residential or inpatient unit;
- client feedback and satisfaction, which, in addition to satisfaction with services, could include measures such as the percentage of clients who indicate a drive time of greater than 30 minutes, or the percentage of clients who say that they have access to public transportation to reach the facility if needed; and
- the satisfaction of other stakeholders, such as high volume referral agents (e.g. judges, court workers, employee assistance agents, and others with repeated experience with network access and services).
Network Administration (NET) 9: Members and Community Partners
NET 9.01
NET 9.02
- providers who are responsive to the diverse cultural needs of clients and are able to connect clients with natural supports; and
- providers who might not otherwise be able to participate in the network because of constraints of size, budgetary capacity, organizational development, or similar limitations, when such inclusion is necessary to allow clients access to providers that meet their needs and preferences.
Network Administration (NET) 10: Network Application Process
NET 10.01
NET 10.02
- establishing continuity of care requirements; and
- assessing the impact that an applying provider organization may have on continuity of care for the network’s service population.
NET 10.03
- making decisions to accept or reject applicants;
- denying admission to the network;
- appealing application decisions; and
- terminating the relationship.
Network Administration (NET) 11: Network Training
NET 11.01
- the network's mission, philosophy, goals, and services;
- network operations and functioning;
- network policies and procedures including access procedures;
- network billing practices;
- utilization management criteria;
- the network's conflict of interest policies and ethical expectations; and
- the provider's role in the network's PQI process.
NET 11.02
- refresher training on network policies, practices, and procedures;
- evidence-based practices, as appropriate to the array of network services; and
- other issues of importance to the network.