Health Plan Accreditation 2020 Public Comment Webinar

November 5, 2018 · Matt Brock


Public Comment Now Open for Health Plan Accreditation 2020

Comment: NCQA Health Plan Accreditation Public Comment

Comments Due: Monday, December 17, 2018

NCQA invites you to comment on the proposed updates to Health Plan Accreditation 2020. In addition to the standards updates, NCQA seeks feedback on proposed changes to scoring, changes to HEDIS®/CAHPS® measures and changes to process. HPA 2020 will be released July 2019.

WHP and MBHO Accreditation 2020 public comment period is also open through December 17.

Public feedback is an important part of developing and updating our programs. NCQA reviews all comments and presents results to its advisory groups for deliberation and approval.

Proposed Changes

The proposed changes below may be modified or eliminated based on public comment and other feedback.

NCQA focused improvements on the following areas:

  • Earning Accreditation

o          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

o          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

o          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 These requirements are outdated or evaluated in other parts of accreditation.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

o          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

o          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.

o          NCQA would retire the Customer Service CAHPS measure for 2020 scoring due to low reliability and ability to report.

  • Utilization Management

o          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.

How does NCQA determine updates?

NCQA receives ongoing feedback from health plans and stakeholders. In addition, NCQA has done extensive research with health plans, employers, states and the federal government, provider organizations and consumers to identify what is important to them. In all cases, updates to Health Plan Accreditation standards aim to improve quality and member experience while removing requirements that may no longer be necessary.

Want More Information?

View this webinar and review the public comment documents for more details on proposed changes, to help you prepare comments.

How to Comment

Access the proposed updates here. After you review them, enter feedback on NCQA’s public comment website.

  • Select Health Plan Accreditation from the Products drop-down menu:
  • Select a HPA element from the Topic drop-down menu. Enter comments and support on overall changes.
  • There are some Targeted Questions that request specific feedback. Select a targeted question under Element.
  • Select a support type (e.g., support with modifications) and provide additional comments (optional).

NCQA values your feedback. We read every comment; many lead to changes in our standards and policies. The review process makes our standards stronger for all stakeholders.

Thank you for participating in public comment and for your commitment to improving health care quality.




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