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Updated: April 1, 2022 – NCQA’s COVID accommodations will not be extended beyond June 30, 2022. Virtual accreditation surveys will continue through 2022.
NCQA would like to express our support of everyone affected by the coronavirus (COVID-19) pandemic. We especially thank the clinicians and other caregivers who are on the front lines to protect us all.
NCQA implemented the exceptions noted below for the March 1, 2020 – June 30, 2022, time frame for all applicable products (e.g., HP, MBHO, UM-CR-PN).
NCQA’s COVID accommodations will not be extended beyond June 30, 2022, but organizations that come through a survey after June 30, 2022 will be eligible to receive NCQA COVID accommodations if the survey look-back period includes the March 1, 2020-June 30, 2022 period. Any further accommodations needed past the June 30, 2022 date will be handled by NCQA on a case-by-case basis.
Organizations that cannot meet NCQA requirements because of changes in operations due to COVID-19 must document modifications made for all applicable standards and file review elements in a disaster management plan. Find details on disaster management plans below.
To request survey accommodations, organizations will complete a COVID-19 Impact Tracker detailing the impact of COVID-19 to applicable elements, as well as any mitigation efforts. The tracker is available at the link below and is also housed in IRT in a COVID-19 link in the Organization Background section. Both the tracker and required disaster management plan will be uploaded to IRT, to be included with survey submissions.
In an effort to adhere to the most up to date COVID-19 traveling precautions recommended by the CDC, NCQA is in the process of determining whether returning to in-person onsite surveys will be considered. Stay tuned for additional information in the next few months.
Practitioners Who Provide Care During a Public Health Emergency
Organizations are not required to credential practitioners who are not part of their network or practice and are providing care to members/patients solely as part of a federal, state or local government emergency response team.
Organizations are not required to credential practitioners who are part of the organization’s emergency response efforts if it documents the disaster management plans that were implemented from March 1, 2020 – June 30, 2022 for allowing these practitioners to provide care for members.
CMS 1135 Waivers for State Licensing
CMS allows states to request a waiver that will temporarily allow out-of-state practitioners to provide services if they are licensed in another state. When credentialing these practitioners in a state that receives a waiver, NCQA will waive the requirement that the organization verify the license to practice for that state.
Accredited and Certified Organizations
For activities where challenges to timeliness may occur, NCQA is making the following changes, effective immediately:
- Extending the grace period 2 months to allow 16 months for annual requirements such as analysis, member communications and delegation oversight.
- Extending the look-back period for Credentialing Committee meeting minutes: If 3 sets of minutes are not available during the look-back period, NCQA will accept however many are available during the look-back period. If none are available during the look-back period, NCQA will accept 1 set of minutes prior to the look-back period.
- Extending the practitioner and provider recredentialing cycle 2 months, to 38 months.
- Extending provisional credentialing status from 60 calendar days to 180 calendar days.
- Removing files from the March 1, 2020 – June 30, 2022 time frame from credentialing, UM denial/appeal and complex case management file reviews for organizations impacted by COVID-19. Impacted organizations should remove those files from the universe that were implemented from March 1, 2020 – June 30, 2022 for credentialing, utilization management and case management and submit their disaster management plans.
- Organizations that were not affected by COVID-19 must include all applicable files, including delegate files, from March 1, 2020 – June 30, 2022 in the appropriate file review universe (CR, UM nonbehavioral denials, UM behavioral denials, UM pharmacy denials, UM appeals, complex case management) and are not required to submit a disaster management plan.
- Organizations that were affected by COVID-19 must submit a disaster management plan and complete the COVID-19 Impact Tracker. The organization’s decision to exclude files because of COVID-19 may differ by file review type (e.g., CR, UM or CCM) but it must exclude all files, including delegate files within the type/category for the impacted month. For months not impacted by COVID-19, all applicable files, including delegate files, must be included. For example, if an organization’s CR process was affected March – June 2020 but not its UM or CCM processes, it must exclude all CR files from the CR file universe for March-June and include all applicable UM and CCM files. Organizations must include or exclude all files for each month and may not remove individual files from a universe.
- Guidance for disaster management plans.
- Guidance for corrective action plan surveys.
- Guidance on analysis requirements that use HEDIS or CAHPS data for Accreditation.
- Additional exceptions pertaining to member/practitioner notification/communication.
- Additional exceptions pertaining to collection of data from members/practitioners.
- Guidance on policy allowances related to telehealth.
Organizations with a survey or evaluation during the COVID accommodation period in 2020-2022 should contact their Accreditation survey coordinator or Recognition account representative. NCQA will determine if additional accommodations (e.g., longer extensions, virtual surveys, shorter look-back periods) are necessary on a case-by-case basis. Please submit all other questions through My NCQA at my.ncqa.org.
NCQA’s goal is to support practices and organizations. We are monitoring the impact of COVID-19 on our customers, adjusting requirements as circumstances warrant and proactively assessing potential scenarios. As always, we will work with individual organizations to accommodate their unique situation.
Guidance on File Reviews Impacted by COVID-19
All surveys must undergo applicable file reviews in order to earn accreditation/certification status.
If files are impacted by COVID-19:
- Submit files from applicable look-back period based on the submission date, excluding full months of impacted files from March 1, 2020 – June 30, 2022. File review will be based on all available files, which may result in low denominators and affect the organization’s overall performance. Normal file review rules apply.
- Extend the look-back period by up to 6 months to capture eligible files. If the number of eligible files is still insufficient, work with your Accreditation Survey Coordinator (ASC) on options.
- Reschedule the file review for First Surveys up to 6 months after the submission date for an additional fee. Normal file review rules apply, and the organization’s status is contingent upon completion of the file review.