Public is Invited to Comment on Proposed Changes to Evaluation Programs

Public Comment is February 27 – March 27, 2012

. — The National Committee for Quality Assurance (NCQA) seeks the public’s input on proposed new programs and changes to seven accreditation and certification programs during a public comment period that begins at 9 a.m. ET on February 27 and ends at 5 p.m. ET on March 27, 2012.

The programs open to public comment are:
  • Value & Delivery System Innovation
  • Case Management
  • Health Plan Accreditation
  • Physician and Hospital Quality (PHQ)
  • Additional 2013 Product Updates: Disease Management, Managed Behavioral Health, Wellness & Health Promotion, Health Information
  • Products and Utilization Management/Credentialing

“We are excited to release these new and revised products and eager to get feedback and input  from a broad range of stakeholders – customers, purchasers, consumer groups and regulators,” said Patricia Barrett, Vice President of Product Development, NCQA. “Public comment is an important part of making our programs as strong as possible.”

Proposed New Programs

NCQA plans to create two new programs:

Value & Delivery System Innovation – This new distinction module is intended to highlight health plans that are at the forefront of addressing cost management. The NCQA program will do this by rewarding health plans that invest in delivery system innovations and pursuing strategies that help purchasers get more value for their health care dollars.

As a distinction module, Value & Delivery System Innovation will be an additional designation available to health plans holding NCQA Accreditation that want to distinguish themselves beyond their regular accreditation status.

Case Management – NCQA is proposing a new Case Management Certification program that will provide Certification for organizations that follow industry best practices in providing case management services. Eligible organizations include disease management vendors, health plans, workers’ compensation organizations and hospitals. Organizations working with Certified Case Management programs can receive points toward NCQA Accreditation or Recognition for other NCQA products.

Proposed Changes to Existing Programs

NCQA plans to revise a number of core programs:

Health Plan Accreditation – NCQA proposes to streamline the accreditation process and reduce administrative burden for new and currently NCQA Accredited health plans. These changes will apply broadly and to plans that wish to operate in the new state Exchanges.

For 2013, NCQA is proposing a single product for Health Plan Accreditation. We are proposing to eliminate New Health Plan Accreditation (NHP) and change the eligibility requirements and structure of the Health Plan Accreditation (HP) product. By having a single accreditation product, we can effectively create a “glide path” that develops plans new to NCQA accreditation, while maintaining a clear distinction between those plans and plans that currently have NCQA accreditation.

Physician and Hospital Quality (PHQ) – Updates to the PHQ program, which evaluates how health plans and other organizations measure and report the quality and cost of physicians and hospitals, are intended to provide consumers and purchasers with greater access to objective and reliable data for making sound decisions using provider-level quality and cost data.

Additional 2013 Product Updates:

Disease Management, Managed Behavioral Health, Wellness & Health Promotion, Health Information Products and Utilization Management/Credentialing - NCQA is proposing several updates to clarify and evolve existing standards.

Additionally, NCQA is proposing minor updates to its Utilization Management/Credentialing product to further align with Affordable Care Act requirements.

About NCQA

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.