Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can ask a question through My NCQA.
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The stem for HO 2, Element D should read as follows: "The organization's methods for evaluating member or patient disability status include:"
Note: Although the stem appears in the e-publication version of the standards, it is not visible in the IRT version of the standards. This will be updated in the IRT version in August 2026.
Applicable standards:
For the purposes of Accreditations in Health Outcomes and Community-Focused Care, a health plan that is seeking accreditation that provides both payor and provider functions (i.e., direct medical or behavioral patient care) is considered both a payer and a care delivery organization. “Direct medical or behavioral patient care” is not intended to include case management for the purposes of Accreditations in Health Outcomes and Community-Focused Care.
A health plan that provides direct medical or behavioral patient care must also meet the following requirements that apply only to care delivery organizations:
A health plan that does not provide direct patient care is not considered a care delivery organization. It is considered a payer only. The requirements listed above that apply only to care delivery organizations would not apply to a health plan that is a payer only.
