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FAQ Directory

Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can  ask a question through My NCQA.

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8.29.2013 Documentation requirement for CVOs using the NPBD-PDS What documentation expectations are there for CVOs that use the NPDB-PDS for collections and reporting of sanction information?

The CVO must provide NCQA with evidence of current or continuous enrollment of the practitioner in the NPDB-PDS, and of review and reporting of NPDB-PDS activity within 120 calendar days to the organizations client. If no sanction information is reported by the NPDB-PDS, the CVO must provide documentation of this in the file and must report to clients that no sanctions were reported. The organization determines its method of documentation.

8.29.2013 Future completion dates for education and training Does NCQA accept future completion dates when verifying education and training?

No. Verification of future completion date does not meet NCQA requirements for verification of the highest level of education and training completed by the practitioner. NCQA requires an actual completion date.

8.16.2013 Childhood Immunization Status On May 16, 2013, the Centers for Disease Control and Prevention (CDC) National Center for Immunization and Respiratory Diseases released a document based on Sanofi Pasteurs Pentacel (DTaP-IPV/Hib) and Daptacel (DTaP) vaccine shortage. Because these vaccines are expected to be in short supply through summer 2013, does NCQA plan any changes to the CIS measure for HEDIS 2014?

No. NCQA will not make any changes to the vaccine requirements for HEDIS 2014. As indicated by the CDC, "Single-component DTaP, IPV, HepB, and Hib vaccines and other age-appropriate licensed combination vaccines are available to complete series begun with Pentacel or Pediarix. Currently, there is a sufficient supply of these products to meet the anticipated demand." You can find additional information in the Guidance for Vaccinating Children during the 2013 Pentacel, Daptacel and Pediarix Shortage article at http://www.cdc.gov/vaccines/vac-gen/shortages/downloads/pentacel-guidance.pdf.

HEDIS 2014

7.15.2013 Using physician groups or IPAs to distribute information to practitioners If an organization contracts with a physician group or IPA, may the physician group or IPA distribute information to its practitioners if covered in the contract? Does NCQA consider this contractual arrangement to be delegation?

The physician group or IPA may distribute information to its physicians if this language is in the contractual agreement. NCQA does not consider this to be delegation. The organization must provide the required information to the physician group or IPA.

UM-CR 2013

7.15.2013 Care for Older Adults If there is a list of medications in the progress note, is a prescribing practitioner or clinical pharmacist's signature alone considered evidence that the list was reviewed for the medication review indicator?

The medication review indicator requires both a medication list and evidence that it was reviewed by the appropriate practitioner. The presence of a medication list with the appropriate practitioner's signature is compliant if it is dated during the measurement year. The practitioner's signature is considered evidence that the medications were reviewed.

HEDIS 2014

7.15.2013 General Guidelines Where can customers find additional information about the supplemental data changes for HEDIS 2014?

7.15.2013 Prenatal and Postpartum Care For the PPC measure, a Pap test alone is acceptable for the Postpartum Care rate. Is documentation of a Pap test compliant for women under the age of 21?

NCQA is aware that recent guidelines recommend pap tests NOT be performed for women under 21 years of age under general circumstances. However, for the PPC measure, a pap test will remain in the specifications as a way to determine that postpartum care occurred. NCQA allows documentation of only a Pap test because this test indicates that a pelvic exam was performed. This measure includes deliveries in any age group.

NCQA is re-evaluating the PPC measure based on clinical practice guideline updates. Any changes will be included in future HEDIS specifications.

HEDIS 2014

6.15.2013 Documentation to meet structural standards if delegated to an NCQA Accredited or Certified organization According to the Automatic Credit for Delegating to an Accredited HP appendix, there are some structural requirements that do not receive automatic credit when delegating to an NCQA Accredited or Certified Health Plan. What documentation is required if the organization accepts the delegates structural requirement as its own?

For all standards/elements that have been identified as structural requirements, the organization must provide its own materials, processes and other data sources as evidence that it meets each structural component of the standard. Organizations may adopt other organizations' procedures as its own. If an organization adopts existing procedures from another organization, it must provide evidence of formal adoption by its governing body or other group or individuals with appropriate authority.

6.15.2013 Delegation documentation for Interim Surveys For organizations coming through Interim Surveys, what documentation is expected to meet the delegation requirements?

For Interim evaluation options, if an organization has not finalized a delegation agreement with an intended delegate, NCQA will accept draft agreements and communications between organizations for delegation requirements. NCQA will review and score the draft agreement and communications defining when the agreement will be complete for Elements A (Written Delegation Agreement) and B (Provision of PHI) in the applicable categories (QI, UM, CR, RR). NCQA will also review documented processes and reports for Element D (Predelegation Evaluation). NCQA will score delegation Element C (Review/Approval of Program, Right to Approve and Terminate, Predelegation Agreement) as Not Applicable. NCQA reserves the right to review and score finalized delegation agreements.

6.15.2013 Number of sets of minutes for Interim Surveys How many sets of minutes are required for Interim Surveys? Many organizations seeking Interim Accreditation will barely be able to have one or two meetings before survey, especially new health plans, like CO-OPs.

For Interim Surveys, NCQA reviews up to three minutes. If there are fewer than 3 meetings, the organization presents the minutes from the meetings it has held.

6.15.2013 Documentation needed for Interim Surveys What documentation is expected for Interim Surveys in QI 7, Element B?

The organization must provide a documented process describing the system, and how it meets the requirements in the element.

6.15.2013 Practitioner involvement in the QI Committee for Interim Surveys Other than review and approveal of policies and procedures, what is expected to meet the requirement of practitioner involvement?

The organization must provide evidence that practitioners were involved in review and approval of policies and procedures.