Public Comment for Proposed Updates to NCQA Programs Are Open

NCQA seeks public comment from a variety of stakeholders on the proposed updates for NCQA’s LTSS Programs, 2024 Accreditation Programs and Health Plan Ratings. Reviewers are asked to submit comments in writing through my.ncqa.org portal by 11:59 p.m. (ET), Tuesday, December 20.

Public comment is open for the following programs. 

NCQA LTSS Programs 

  • LTSS Distinction in Health Plan Accreditation 
  • Case Management-LTSS Accreditation 

2024 Accreditation Programs 

  • Health Plan Accreditation 
  • MBHO Accreditation 

Health Plan Ratings 

  • Health Plan Ratings 2023 
  • Health Plan Ratings 2024 

LTSS Program Updates 

Updates that apply to both CM-LTSS Accreditation and LTSS Distinction  

Populations  

  • NCQA recommends including all populations that receive long-term services and supports, such as persons with intellectual and/or developmental disabilities, children with disabilities, persons with serious mental illness, persons with traumatic brain injury and others. 

Health Equity 

  • Quality health care often depends on a population’s race, culture, religion, class, gender identity, sexual orientation, geography or language. NCQA recognizes our opportunity and obligation to strengthen and transform delivery of long-term services and supports.  

Person-Centered Goals 

  • Person-centered care is critical, especially for populations that receive long-term services and supports. Adding person-centered goals to these programs will put organizations on a glidepath to track person-centered goals using a standard approach. 

LTSS Distinction-Only Updates  

Patient Protections: Service Authorizations 

  • Responding to the GAO’s findings regarding inappropriate service authorization denials and delays, NCQA proposes new requirements to guide standardization of organizational processes and criteria for authorizing and denying initial service requests. 

CM-LTSS Accreditation Updates  

Clinical Integration and Coordination 

  • Area Agencies for Aging and community-based organizations provide a variety of services. NCQA proposes to highlight organizations that provide clinically integrated and coordinated care services by adding a new feature to the NCQA Report Card. 

Product Design 

  • NCQA proposes an Interim Survey option for organizations seeking CM-LTSS Accreditation. Status will be valid for up to 18 months, making the path to Full Accreditation more in alignment with organizations’ business processes and survey preparations.  

NCQA relies on stakeholder input to enhance and evolve our programs. We encourage you to provide insights and feedback on proposed updates, including challenges to meeting the new requirements; the value to your organization from demonstrating additional capabilities; and any other considerations for contracting in managed care. 

LTSS Updates:

How to Submit Comments 

NCQA reviews all feedback submitted during the public comment period.  

  1. Go to My NCQA and enter your email address and password.  
  1. Once logged in, scroll down and click Public Comments. 
  1. Click Add Comment to open the comment box.  
  1. Click to select Proposed Updates for LTSS Distinction for Health Plan Accreditation and CM-LTSS Accreditation from the drop-down box.  
  1. 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.  
  1. 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.  

Use the Submit button to submit more than one comment. Use the Close button to finish leaving comments; you can view all submitted comments in the Public Comments module.  

Reviewers are asked to submit comments by 11:59 p.m. (ET) on Tuesday, December 20. Visit the NCQA website to learn more. 

2024 Accreditation Programs  

Proposed updates to the 2024 standards and guidelines were informed by feedback from health plan organizations, NCQA surveyors and stakeholders such as consumers, states and CMS. Proposed updates include changes to the scoring thresholds of existing requirements. 

For Health Plan and MBHO Accreditation, NCQA proposes updates to scoring thresholds for long-standing requirements. These requirements will take effect July 1, 2024. 

Proposed Changes for Health Plan Accreditation 2024 

Scoring Threshold Updates 

  • PHM 2, Element A: Data Integration. 
  • PHM 5, Element C: Case Management Process. 
  • ME 5, Element A: Pharmacy Benefit Information—Website. 
  • ME 5, Element B: Pharmacy Benefit Information—Telephone. 
  • ME 6, Element D: Email Response Evaluation. 

Proposed Changes for MBHO 2024 

Scoring Threshold Updates 

  • QI 8, Element G: Case Management Process. 

MBHO and HPA Updates:

How to Submit Comments 

NCQA reviews all feedback submitted during the public comment period.  

  1. Go to My NCQA and enter your email address and password.  
  1. Once logged in, scroll down and click Public Comments. 
  1. Click Add Comment to open the comment box.  
  1. Click to select either/both Proposed Updates for Health Plan Accreditation 2024 and Proposed Updates for MBHO Accreditation 2024 from the drop-down box.  
  1. 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.  
  1. 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.  

Use the Submit button to submit more than one comment. Use the Close button to finish leaving comments; you can view all submitted comments in the Public Comments module.  

Reviewers are asked to submit comments by 11:59 p.m. (ET) on Tuesday, December 20. Visit the NCQA website to learn more. 

Health Plan Ratings 2023 and Health Plan Ratings 2024 

NCQA seeks feedback on proposed changes to required measures for Health Plan Ratings 2023 and 2024. 

A critical issue for any quality rating tool is certainty of judgment: Stakeholders want to be sure that plans assigned a higher value deserve it. If a rating system includes redundant measures or measures with poor statistical properties, it risks rewarding random variation over true quality differences. 

Proposed Changes for Health Plan Ratings 2023 

NCQA proposes to remove the following measures: 

  • Claims Processing (Commercial) 
  • Coordination of Care (Medicaid) 
  • Rating of Specialist (Medicaid) 

Proposed Changes for Health Plan Ratings 2024 

NCQA proposes to revise one existing measure, remove seven measures and add one new measure. 

Measure for revision 

  • Replace Breast Cancer Screening (BCS) with the ECDS reporting version of the measure, Breast Cancer Screening (BCS-E), for all product lines. 

Measures for removal 
Use of Opioids at High Dosage (HDO)–all product lines 
Use of Opioids From Multiple Providers (UOP)—Multiple Prescribers and Multiple Pharmacies rate—all product lines 
Risk of Continued Opioid Use (COU)—all product lines 
Flu Vaccinations for Adults Ages 18-64 (FVA)—commercial and Medicaid product lines 
Flu Vaccinations for Adults Ages 65 and Older (FVO)—Medicare product line 
Pneumococcal Vaccination Status for Older Adults (PNU)—Medicare product line 
Annual Dental Visit (ADV)—Medicaid product line 

New measure: 

  • Adult Immunization Status (AIS-E)—all product lines 

HPR Updates:

How to Submit Comments 

NCQA reviews all feedback submitted during the public comment period.  

  1. Go to My NCQA and enter your email address and password.  
  1. Once logged in, scroll down and click Public Comments. 
  1. Click Add Comment to open the comment box.  
  1. Click to select Proposed Updates for Health Plan Ratings 2023 and Health Plan Ratings 2024 from the drop-down box.  
  1. 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.  
  1. 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.  

Use the Submit button to submit more than one comment. Use the Close button to finish leaving comments; you can view all submitted comments in the Public Comments module.  

Reviewers are asked to submit comments by 11:59 p.m. (ET) on Tuesday, December 20. Visit the NCQA website to learn more. 

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