NCQA > Programs > Accreditation > MBHO Accreditation > Working with an NCQA-Accredited MBHO

The Advantages of Working with NCQA-Accredited MBHOs

NCQA awards automatic credit on certain elements (in other words, 100% compliance) to organizations that contract with NCQA-Accredited MBHOs. This policy is designed to streamline the accreditation process and encourage the development of lasting, mutually beneficial partnerships between NCQA-Accredited organizations.

These advantages are available to HPs that delegate to NCQA-Accredited MBHOs and whose delegation agreements are active at the time of their survey. (There are exceptions for agreements that have been terminated). This applies for an HP that did not delegate behavioral health to an MBHO when the MBHO was surveyed.

1. Automatic credit is received for the following elements if at least 70 percent of an HP's total membership is covered by the NCQA-Accredited MBHO's services and the agreement includes the specific responsibilities listed.

QUALITY IMPROVEMENT
QI 1: Element A— factors 2, 6	The authority to select QI topics relevant to its population, to design activities and analyze results of the activities, to implement interventions and to evaluate results of the interventions.
QI 4: Element D	The authority to perform behavioral health services availability functions.
QI 5: Elements B, C	The authority to perform behavioral health services accessibility functions.
QI 9: For behavioral health guideline— Element A—factors 1–3; Element C	The authority to adopt and disseminate 2 behavioral health clinical practice guidelines.
UTILIZATION MANAGEMENT
UM 1: Element A— factors 2, 4; Element C	The authority to evaluate and determine the appropriateness of the utilization of behavioral healthcare services and to provide any needed assistance to clinician or patient in cooperation with other parties to ensure appropriate use of resources. UM includes preservice (prior authorization), concurrent review, postservice (retrospective review), discharge planning and case management.
UM 4: Element D UM 5: Elements C, D UM 6: Element D UM 7: Elements E–G	The authority to evaluate and determine the appropriateness of the utilization of behavioral healthcare services and to provide any needed assistance to clinician or patient in cooperation with other parties to ensure appropriate use of resources. UM includes prior authorization, concurrent review, retrospective review, discharge planning and case management. This delegation results in full credit for any MBHO files selected and all review elements counted compliant.
UM 9: For behavioral health files—Elements A–E	The authority to evaluate and determine the appropriateness of appeals. This delegation results in full credit for any MBHO files selected and all review elements counted compliant.
UM 10: Element A—factor 2	The authority to evaluate new behavioral health procedures and the new application of existing behavioral health procedures.
UM 12: For behavioral health files—Elements B, C	The authority to evaluate ER visits or claims. This delegation results in full credit for any MBHO files selected and all review elements counted compliant.
UM 14 All elements	The authority to provide behavioral health triage and referral functions.
CREDENTIALING
For behavioral health files: CR 3: Elements A, B CR 4: Element A CR 5: Element A CR 7: Elements A–D	The authority for primary source verification and credentialing/recredentialing decision making, which results in full credit for any MBHO files selected and all review elements counted compliant. The authority for primary source verification only, which results in verification elements automatically being considered present and current. Only timeliness is reviewed.
CR 8: Element A	Meeting the recredentialing cycle length
CR 11: Elements C, E	The authority to credential behavioral health organizational providers.

2. Full credit on MBHO file pulls:

CR: During an HP survey, behavioral health files may be included in the CR file review, as delegate files are included in the total universe from which NCQA selects the sample. The HP receives full credit if such a behavioral health file is pulled and the delegate is responsible for primary source verification and decision making because all review elements are counted as present.
UM (denials, appeals and ER files): This file pull is random; surveyors select a sample of files, and delegate files are included in the total number from which NCQA selects the sample. The HP receives full credit if a behavioral health file is pulled.

3. Requirements for oversight are reduced:

NCQA does not require an HP to conduct predelegation audit/evaluations if it contracts with an accredited MBHO.
Once an HP contracts with an accredited MBHO, NCQA does not require an annual oversight audit.
NCQA does not require the HP to conduct file review/audits of an accredited MBHO.

As stated in the 2008 NCQA HP Standards and Guidelines, " When an organization delegates defined activities to an NCQA-Accredited or NCQA-Certified organization, the expectation of a formal predelegation evaluation, annual evaluation and annual audit, as applicable, and the determination of meeting NCQA standards are satisfied for activities covered within the delegate’s NCQA-Accreditation or NCQA-Certification survey. NCQA waives the predelegation assessment and annual oversight requirements of NCQA-Accredited or NCQA-Certified delegates. Oversight relief is not available for activities that are not covered—including NA activities—within the scope of a delegate’s NCQA-Accreditation or NCQA-Certification survey." (Appendix 3 - Delegation, p. 3-11).

4. NCQA does not expect the organization to produce the MBHO's full documentation as part of its evidence during its survey:

The HP may reference the MBHO material as a separate document.
HPs are held to the behavioral health requirement of the HP standard, not the MBHO standard itself.

Refer to Automatic Credit for Delegating to an NCQA-Accredited MBHO in Appendices 3 and 4 of the 2008 Standards and Guidelines for the Accreditation of Health Plans.