Health Plan Accreditation Public Comment 

March 11, 2015 · NCQA

Share your comments by April 8, 2015

NCQA invites the public to comment on proposed changes to NCQA Health Plan Accreditation (HPA).

This provides an opportunity for insurers, consumers, employers and other stakeholders to advise NCQA on the primary way the organization evaluates health plans.

NCQA is updating the HPA program to incentivize plans to focus on value-based strategies. Proposed changes include:

  • Developing a more comprehensive assessment of network adequacy and provider directory accuracy by updating existing requirements and adding new requirements in a new category of standards: Network Management.
  • Including new requirements to strengthen NCQA’s ability to detect systematic issues related to Utilization Management.
  • Simplifying scoring for file review elements in HPA and other accreditation/certification products that contain these elements.

In addition to HPA standards updates, NCQA proposes policy changes to the following programs:

  • Managed Behavioral Healthcare Organization Accreditation (MBHO)
  • Wellness and Health Promotion Accreditation (WHP)
  • Credentials Verification Organization Certification (CVO)
  • Health Information Products Certification (HIP)
  • Utilization Management and Credentialing Certification (UM/CR)

How to Participate in Public Comment

Read and comment on the proposed changes online. The Public Comment period begins at 9 a.m. ET on March 11 and ends at 5 p.m. ET on April 8, 2015. NCQA will review input from the Public Comment and release the final HPA 2016 Standards and Guidelines on July 27, 2015. They will be effective starting July 1, 2016.

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