Coronavirus and NCQA

Updated: June 1, 2020. Based on ongoing updates from the CDC and other authorities, we have enacted these policies for NCQA staff, contractors, customers 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. 

SUMMARY: HEALTH PLANS

Data Reporting and Uses, by Product Line

Updated: April 23, 2020

Medicare AdvantageExchangeCommercial & Medicaid
HEDIS Measurement Year 2019Reporting data to NCQA is not required, per CMS guidance.

NCQA's HEDIS reporting systems and tools remain available to support internal plan quality improvement activities.
Reporting data to NCQA is not required, per CMS guidance.

NCQA's HEDIS reporting systems and tools remain available to support internal plan quality improvement activities.
Plans should report data to NCQA.

NCQA will work with plans whose ability to report data is compromised, in order to make accommodations.

NCQA will abide by different states’ decisions about data reporting.
CAHPS Not collected by NCQA.QHP Enrollee Survey not collected by NCQA.Plans should report data to NCQA.

NCQA will work with plans whose ability to report data is compromised, in order to make accommodations.

NCQA will abide by different states’ decisions about data reporting.
NCQA Health Plan AccreditationPlans not required to report data to NCQA.

Accreditation will not incorporate NCQA Health Plan Ratings in 2020.
Plans not required to report data to NCQA.

N/A: Exchange not included in NCQA Health Plan Ratings.
Plans should report data to NCQA.

Accreditation will not incorporate NCQA Health Plan Ratings in 2020.
NCQA Health Plan Ratings 2020CanceledN/ACanceled
Quality Compass 2020CanceledN/AHEDIS: Will review for our usual standards of validity, accuracy and completeness.

CAHPS: CAHPS survey results will not be included in Quality Compass.

HEDIS and CAHPS

Guidance on HEDIS and CAHPS Reporting

Updated: April 27, 2020

NCQA understands that the national priority at this time must be to allow the health care system to focus on addressing the COVID-19 crisis.

Concerning the collection of HEDIS® and CAHPS® for Health Plan Accreditation for Measurement Year 2019 (MY2019), feedback on readiness to report has been mixed.  While some plans are eager to report their results, others are challenged to do so.

To create the flexibility needed to allow quality reporting to move forward, we have previously announced policy modifications at www.ncqa.org/covid and in our memo of March 13.

NCQA is now announcing the following policy decisions by product line:

Medicare Advantage Accreditation and Reporting:
As stated in the Medicare and Medicaid Programs: Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency Interim Final Rule, put on display at the Office of the Federal Register website on March 31, 2020, CMS eliminated requirements for the collection of HEDIS and CAHPS data that would otherwise occur in 2020 for Medicare Advantage (MA) plans. In alignment with CMS’ decision, NCQA will not be requiring MA plans to submit their data for accreditation purposes.  MA plans may use the IDSS tool for internal purposes but, as noted above, reporting is not required.

Exchange Accreditation and Reporting:
As stated in the COVID-19 Marketplace Quality Initiatives memo posted on April 18, 2020, CMS is suspending activities related to the collection and reporting of data related to the QRS and the Qualified Health Plan (QHP) Enrollee Survey for the Plan Year (PY) 2021 QHP Certification Period.  CMS is directing all eligible QHP issuers to discontinue the collection of survey measure data and clinical quality measure data including HEDIS data that would normally be reported to CMS in May and June 2020. In alignment with CMS’s decision, NCQA will not be requiring QHP issuers to submit their data for accreditation purposes. QHP issuers may use the IDSS tool for internal purposes but, as noted above, reporting is not required for PY 2021.

Commercial and Medicaid Accreditation and Reporting:
For accredited commercial and Medicaid plans, NCQA is proceeding with our annual requirements for collection of HEDIS and CAHPS data through our IDSS tool. Non-accredited plans may also submit.

While HEDIS and CAHPS reporting remains a required component of Commercial and Medicaid accreditation, we expect that the data we receive will likely not lend itself to calculation of an overall plan rating.

Therefore, NCQA will not use Health Plan Ratings for Accreditation scoring in 2020. We will continually assess the feasibility of using the data reported to us for other purposes, provided they meet our usual standards for validity, accuracy and completeness.

For HEDIS FAQs related to COVID-19, click here.

Exceptions:
Out of respect for the efforts focused on COVID-19, we have implemented our disaster protocols which allow for exceptions to these reporting requirements. For commercial and Medicaid plans whose ability to submit HEDIS or CAHPS data is compromised, NCQA will work with the organization to determine the appropriate accommodations.

State Reporting: We respect that different states may make different decisions on HEDIS and CAHPS reporting and we will abide by those decisions on a state-by-state basis.

In all cases, the IDSS tool will be available for internal quality improvement purposes.

Health Plan Report Cards and Health Plan Ratings

Updated: April 3, 2020

Due to changes in HEDIS and CAHPS reporting outlined above:

  • The September 2020 Health Plan Report Card update will list all plans with Interim, Accredited or Provisional status, as applicable, based on existing status or standards performance for surveys on the HPA 2020 Standards.
  • There will be no Health Plan Ratings in 2020.

Guidance on HEDIS for LTSS

Updated: April 28, 2020

HEDIS Long Term Services and Supports Measures Reporting

For Measurement Year 2020, NCQA is relaxing requirements that comprehensive assessments and care planning discussions must occur with members face-to-face or in the member’s home. Comprehensive assessments and care planning discussions with members may be conducted face-to-face in the member’s home or at alternate locations, or using synchronous methods (i.e., telephone visits or videoconferencing) for the following measures:

  • Comprehensive Assessment and Update
  • Comprehensive Care Plan and Update
  • Re-assessment and Care Plan Update after Inpatient Discharge

Accreditation and Recognition

Accreditation Requirements (March-September)

Updated: May 27, 2020

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.

Although federal guidance and local circumstances continue to evolve, NCQA is implementing the exceptions noted below for the March 1–September 30, 2020, time frame for all applicable products (e.g., HP, MBHO, UM-CR-PN). This applies to all future surveys that include this look-back period. We will give updates as needed and when new information becomes available.

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 new 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.

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–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.

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–September 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–September 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 from March–September 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 remove all CR, UM denial/appeal or complex case management files, as applicable, and must submit disaster management plans. For example, if an organization’s CR process was affected but not its UM processes, it must exclude all CR files from the CR file universe for March-September and include all applicable UM files. Organizations must include or exclude all files and may not remove individual files from a universe.

Organizations with a 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 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.

Recognition Requirements (March-September)

Last updated: May 12, 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 30, 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.

We suggest primary care practices consult and complete The Green Center’s weekly COVID survey. While NCQA does not issue or manage this survey, we believe the information gathered is meaningful. The survey helps practices understand and report primary care’s capacity to respond to COVID-19.

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.

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.

PUBLIC POLICY

State Briefing & Policy Discussion

Updated: May 8, 2020

The NCQA Public Policy team hosted a webinar for state officials on Wednesday, April 1 to explain how NCQA’s COVID-19 response affects state programs, and to take questions.

NCQA Events

Education Seminars

Last updated: June 1, 2020

Our in person seminars have been converted to virtual, online trainings. We offer live webinars and self-paced on demand trainings.

Digital Quality Summit (July 22–23)

Updated: May 19, 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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