Coronavirus and NCQA

Updated: March 27, 2020. Based on ongoing updates from the CDC and other authorities, we have enacted these policies for NCQA staff, contractors and events.

NCQA:

  • Is prepared to conduct all business activities virtually, if necessary.
  • Will continue to deliver all systems, surveys, support services, contract and grant-related services.
  • Is assessing large meetings, events and conferences with the goal of converting them to virtual events.

Check back on this page for updates. We will update policies as new information about COVID-19 becomes available. 

HEDIS

HEDIS Data Collection & Reporting (March-June)

Updated: March 27, 2020

  • Organizations should continue to use medical record procurement processes that do not require travel, including virtual/online reviews and fax/mail.
  • For commercial and Medicaid plans reporting to NCQA, for measures reported using the hybrid methodology only, we will allow plans to report their audited HEDIS 2019 hybrid rate if it is better than their HEDIS 2020 hybrid rate.
    • Relatedly, we amended earlier guidance on our website and FAQs about low chart retrieval because access to chart data varies plan to plan.
  • We understand guidance will come from CMS regarding Medicare health plans and commercial plans reporting for the Health Insurance Exchange Quality Ratings System. For details on this, see the full memo.
  • For details on guidance we’ve given NCQA Certified CAHPS Survey Vendors, click here.
  • For HEDIS FAQs related to COVID-19, click here.

Accreditation and Recognition

Accreditation Requirements (March-September)

Updated: March 24, 2020

NCQA would like to express our support of everyone affected by the coronavirus (COVID-19) outbreak. We especially thank the clinicians and other caregivers who are on the front lines to protect us all.

Although federal guidance and local circumstances continue to evolve, NCQA is implementing the exceptions noted below for the March 1–September 1, 2020, time frame. This applies to all future surveys that include this look-back period. We will give updates as needed and when new information becomes available.

Practitioners Who Provide Care During a Public Health Emergency

Organizations do not need to credential practitioners who are not part of their network or practice and are providing care to members/patients as part of a federal, state or local government emergency response team.

Organizations do not need 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–September 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.

Other Federal and State Responses

NCQA understands that state governors and other government officials are responding to changing conditions in their localities with COVID-19 regulation. NCQA will not penalize organizations when these regulatory responses may prevent an organization from meeting an NCQA accreditation requirement (e.g., suspension of routine communication to members and practitioners). NCQA scores the organization NA if a requirement would put it in conflict with a federal or state regulation, including emergency response regulation. The organization must provide evidence of regulatory conflict at the time of the organization’s accreditation survey.

Health Care Organizations and Practices Whose Operations Are Affected

NCQA understands that normal operations have been disrupted in many communities, which could affect organizations’ ability to meet NCQA requirements. NCQA will be flexible in scoring organization performance during the March–September time frame. Organizations will need to provide documentation regarding the circumstances that interfered with meeting requirements.

Note: Recognition practices may show evidence from any time in the past year, so organizations may demonstrate that activities were routinely implemented before and after the March–September time frame.

Accreditation and Certification 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.
  • Removing files from the March–September time frame from credentialing, UM denial/appeal and complex case management file reviews. Organizations should remove these files from the universe and document the disaster management plans that were implemented from March–September for credentialing, utilization management and case management.

After this time period when credentialing activities resume in accordance with NCQA requirements, the organization may extend:

  • The practitioner and provider recredentialing cycle 2 months, to 38 months.
  • Provisional credentialing status from 60 days to 180 days.

Organizations with an upcoming survey or evaluation in 2020 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 https://my.ncqa.org.

We know that patients and members are your priority during this time, and our goal is to support you as much as we can. NCQA is monitoring impacts to our customers and adjusting requirements as the circumstances warrant. Although this situation is unprecedented, we are proactively assessing potential scenarios. As always, we are prepared to work with individual organizations to accommodate unique situations.

Recognition Requirements (March-September)

Updated: March 24, 2020

NCQA would like to express our support of everyone affected by the coronavirus (COVID-19) outbreak. We especially thank the clinicians and other caregivers who are on the front lines to protect us all.

Although federal guidance and local circumstances continue to evolve, NCQA is implementing the exceptions noted below for the March 1–September 1, 2020, time frame. This applies to all future surveys that include this look-back period. We will give updates as needed and when new information becomes available.

Practitioners Who Provide Care During a Public Health Emergency

Organizations do not need to credential practitioners who are not part of their network or practice and are providing care to members/patients as part of a federal, state or local government emergency response team.

Organizations do not need 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–September 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.

Health Care Organizations and Practices Whose Operations Are Affected

NCQA understands that normal operations have been disrupted in many communities, which could affect organizations’ ability to meet NCQA requirements. NCQA will be flexible in scoring organization performance during the March–September time frame. Organizations will need to provide documentation regarding the circumstances that interfered with meeting requirements.

Note: Recognition practices may show evidence from any time in the past year, so organizations may demonstrate that activities were routinely implemented before and after the March–September time frame.

Organizations with an upcoming survey or evaluation in 2020 should contact their 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.

We know that patients and members are your priority during this time, and our goal is to support you as much as we can. NCQA is monitoring impacts to our customers and adjusting requirements as the circumstances warrant. Although this situation is unprecedented, we are proactively assessing potential scenarios. As always, we are prepared to work with individual organizations to accommodate unique situations.

NCQA Events

NCQA 30th Anniversary Gala (April 27)

Updated: March 13, 2020

  • To be postponed until Fall 2020.

Quality Talks (April 28)

Updated: March 13, 2020

  • Quality Talks is no longer an in-person event.
  • Audience access and participation will be 100% online.

Education Seminars (May)

Updated: March 13, 2020

  • Introduction to Health Plan Accreditation (May 5-6): To be rescheduled and augmented with virtual programs. Details are here.
  • Introduction to PCMH (May 5-6): To be rescheduled and augmented with virtual programs. Details are here.
  • PCMH Annual Reporting–Continued Success (May 6): To be rescheduled as a webinar series in June. Details are here.
  • Advanced PCMH: To be rescheduled and augmented with virtual programs. Details are here.
  • Introduction to NCQA’s Credentialing Standards (May 26-27): To be rescheduled and augmented with virtual programs. Details are here.
  • Advanced Credentialing (May 28): To be rescheduled and augmented with virtual programs. Details are here.

Surveyors & Surveyor Update Training

Updated: March 9, 2020

  • Reduce Accreditation-related travel by NCQA staff and external surveyors to the minimum necessary between now and May 31.
  • Surveyors will receive information from their ASC about next steps.
  • The May 18–19 Surveyor Update Training will not be an in-person event. We intend to combine on-demand video and live interactive webinars instead.

Digital Quality Summit (July 22–24)

Updated: March 9, 2020

PCMH Congress & Health Care Quality Congress (September 23–26)

Updated: March 25, 2020

We will continue to follow the COVID-19 situation and make decisions accordingly.

We will keep our staff, colleagues and partners informed as we learn more.

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