NCQA will not require certain mail notification to members or practitioners through the March 1, 2020 – June 30, 2021 time frame. Annual mailings planned during this period may be suspended until the organization’s next scheduled cycle.
This exception applies to the elements in the table below. It identifies applicable elements in HP 2019 and 2020; however, guidance applies to applicable requirements in derivative products (e.g., MBHO, UM-CR-PN).
Applicable elements in HP 2019 and 2020
|HP 2020||HP 2019|
|NET 4, Element A: Notification of Termination||NET 5, Element A|
|NET 4, Element B: Continued Access to Practitioners||NET 5, Element B|
|NET 5, Element J: Availability of Directories||NET 6, Element L|
|Policies and Procedures, Section 2||UM 4, Element G|
|UM 2, Element B: Availability of Criteria||UM 2, Element B|
|UM 11, Element A: Pharmaceutical Management Procedures||UM 11, Element A|
|UM 11, Element B: Pharmaceutical Restrictions/Preferences||UM 11, Element B|
|ME 1, Element B: Distribution of Rights Statement||RR 1, Element B|
|ME 2, Element A: Subscriber Information||RR 3, Element A|
Although NCQA will not require organizations to submit files for review during March 1, 2020 – June 30, 2021, we have not waived the requirement for time-sensitive notices to members regarding specific clinical circumstances or for UM or pharmaceutical recalls (UM 4 – 11).