2018 Medicaid Deeming Module
Public Comment Period: January 22 through February 9, 2018
NCQA is seeking public comment on the 2018 Medicaid Deeming Module. Reviewers are asked to submit their comments in writing via NCQA’s public comment website by 5:00 p.m. (EST) on Friday, February 9, 2018.
2018 Medicaid Deeming Module
The NCQA Health Plan (HP)-Medicaid Deeming Module is based on federal regulations for state administered Medicaid programs, and aligns with current Medicaid requirements under the Medicaid Managed Care Rule (MMC). The goal of the module is to reduce burden on state Medicaid programs and their contracted Medicaid plans so resources can be used where they are most needed: on beneficiaries.
NCQA is seeking feedback from interested stakeholders on the 2018 Medicaid Deeming Module. NCQA asks respondents to consider whether the requirements are feasible as written and are clearly articulated, and to highlight areas that might need clarification. NCQA encourages detailed and specific suggestions to proposed requirements, to facilitate a final set of standards that are valuable to all.
Although feedback for all requirements in the 2018 Medicaid Module is welcomed, targeted feedback is requested on the two topics outlined below. The questions can be found on the public comment website under “Topics” for the “Corrective Action Plan (CAP) Process” or “File Review.”
- Corrective Action Plan (CAP) Process. An organization that receives a performance score of Not Met for one or more elements is required to implement a CAP for each element. A CAP is considered complete when NCQA notifies the organization that all corrective actions have been implemented. NCQA includes a notice of Corrective Actions Required (CAR) in the report for each Not Met element. Is the CAP process outlined in the policies and procedures appropriate for this Medicaid program?
- File Review. The current scope of review for the following elements is limited to evaluation of an organization’s documented process (e.g., policies and procedures), reports or materials. Is file review evaluation more appropriate for the requirements listed below?
- MED 5, Element B: Maintaining and Sharing Member Health Records.
- MED 6, Element A: Initial Screening of Member Needs.
- MED 9, Element A: UM Denial Notifications.
- MED 9, Element B: LTSS Requests for Initial and Continuing Authorization of Services.
- MED 10, Element C: Grievance and Appeal Records.
- MED 10, Element D: Actions After an Appeal is Overturned.
To review the 2018 Medicaid Deeming Module and provide public comment feedback, please see:
About Public Comment
The public comment system is integrated with NCQA’s single-sign on platform. If you have access to any of the systems listed below, you can use the same credentials to login and submit comments:
- Interactive Data Submission System (IDSS).
- Health Organization Questionnaire (HOQ).
- Download Center.
- Recognition Program Online Application.
- Quality Compass (QC).
- Policy/Program Clarification Support (PCS).
Note: Use the Forgot Password if you are unsure of your password. By using this feature, you will change your password for all NCQA systems to which you have access.
If you do not have access to any system listed, click the Create an Account button and complete the entire form. Retain the password for your records.
Submit all comments through NCQA’s Public Comment Web site (http://publiccomments.ncqa.org). NCQA does not accept comments via mail, e-mail or fax.
All comments are due by 5 p.m. (ET) on Friday, February 9.
To enter comments:
- Go to the Public Comment database.
- Enter your e-mail address and contact information.
- Select the following: 2018 Medicaid Deeming Module.
- Click on the Instructions link to the view public comment materials including instructions, Public Comment Memo, 2018 Medicaid Deeming Module Policies and Procedures and Standards and Guidelines.
- Select the Topic and Element (i.e., question) on which you would like to comment.
- Select your support option (i.e., Support, Do not support, Support with modifications).
If you choose Do not support, include your rationale in the text box. If you choose Support with modifications, enter the suggested modification in the text box.
- Enter your comments in the Comments box.
Note: There is a 2,500 character limit for each comment. Be concise in your feedback. We suggest you develop your comments in Word to check your character limit, and save a copy for reference. Use the “cut and paste” function to copy your comment into the Comments box.
- If you are submitting more than one comment use the Submit and Return button. When you have submitted all comments use the Submit and Logout button to receive an e-mail notification with all submitted comments.
All comments are due Friday, February 9, by 5:00 p.m. ET.