Proposed Updates for Health Plan Accreditation 2020

Comment Period – November 5 – December 17, 2018.
All comments are due Monday, December 17 by 5:00pm ET.

NCQA focused improvements on the following areas:

Earning Accreditation

  • Although Health Plan Accreditation would continue to be a performance-based evaluation program, Accreditation status would be based on meeting a predetermined percentage of elements in each standard category (e.g., UM), including must-pass elements. Organizations would continue to submit HEDIS/CAHPS measures and will be evaluated using the NCQA Health Plan Ratings methodology.

Accreditation Status and Health Plan Star Ratings

  • Currently an accredited health plan receives an accreditation status (e.g. Commendable, Excellent) and separately receives a numeric score as part of NCQA Health Plan Ratings.
    • NCQA would eliminate “Commendable” and “Excellent” Accreditation status, as feedback indicated that many found it difficult to distinguish among Accreditation statuses.
    • Organizations would instead earn star ratings (0-5) through NCQA Health Plan Ratings, which is largely based on HEDIS/CAHPS scores. Consumers indicated a star rating is preferred way of viewing ratings so the existing 0-5 Ratings numbers will have these new symbols in 2020.
    • NCQA would tie Health Plan Ratings to Accreditation status by requiring plans to maintain a minimum rating to keep accreditation status.

Retired requirements

  • NCQA would eliminate 15% of Standards and Guidelines requirements. These requirements are outdated or evaluated in other parts of accreditation. This saves health plans time and resources during the survey preparation process.

Renewal

  • Organizations undergoing Renewal Surveys would submit evidence for a smaller set of requirements demonstrating implementation of important quality programs and consumer protections (e.g., file review, reports). Organizations would attest to meeting the remaining standards. Up to 90% of organizations would be eligible for this option, saving time and resources. The smaller set of requirements represents a ~48% reduction in the number of elements that will be reviewed during renewal for HPA 2020, compared with HPA 2019.

HEDIS/CAHPS Measures for 2020

  • NCQA is adding existing measures to Health Plan Accreditation scoring (aka Ratings). NCQA would add 5 new measures for the commercial product line, 11 new measures for the Medicare product line and 4 new measures for the Medicaid product line. The goal is to include measures that meaningfully distinguish health plan performance and balance the number of measures per product line. Historically, Medicare has had at least 10 fewer measures than commercial and Medicaid.
  • NCQA would retire the Customer Service CAHPS measure for 2020 scoring due to low reliability and ability to report.

Utilization Management

  • NCQA would strengthen consumer protections and the accountability of organizations to maintain or improve their capacity to execute important UM functions by:
    • Adding required review by product line for all UM file review elements.
    • Changing the data source specific to UM Timeliness Elements from files to standardized electronic data reporting

Long-Term Services & Supports

  • NCQA would allow organizations seeking LTSS Distinction to report HEDIS LTSS measures in lieu of certain standards. Organizations would meet specified thresholds of performance on HEDIS LTSS measures to earn credit.

The proposed changes below may be modified or eliminated based on public comment and other feedback. Changes to HPA 2020 will be effective July 1, 2020.

Documents

About Public Comment

The public comment system is integrated with NCQA’s single-sign-on platform. If you have access to any system listed here, you can use the same credentials to log in and submit comments:

  • Interactive Data Submission System (IDSS).
  • Health Organization Questionnaire (HOQ).
  • Download Center.
  • Recognition Program Online Application.
  • Quality Compass (QC).
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Submitting Comments

Submit all comments through the my.ncqa.org. NCQA does not accept comments via mail, e-mail or fax.

To enter comments:

  1. Go to My NCQA and enter your email address and password to login.
  2. Under My Services, select Public Comments
    1. Click the Open Public Comments link to view instructions, proposed requirements and questions.
  1. Click the Add Comment button to open the comment box.
  2. Select from the following topics:
    1. Health Plan Accreditation (HPA) 2020 Updates from the product drop-down list.
    2. Health Plan Accreditation (HPA) 2020: Long-Term Services and Supports (LTSS) from the product drop-down list.
  3.  Click to select the Topic and Element (question) on which you would like to comment.
  1. Click to select your support option (Support, Do not support, Support with modifications).
    1. If you choose Do not support, include your rationale in the text box.
    2. If you choose Support with modifications, enter the suggested modification in the text box.
  1. Enter your comments in the Comments box.Note: There is a 2,500-character limit for each comment. We suggest you develop your comments in Word to check your character limit; use the “cut and paste” function to copy your comment into the Comments box.
  1. Use the Submit button to submit more than one comment. Use the Close button to finish submitting comments; you can view all submitted comments in the Public Comments
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