FAQ Directory

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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10.15.2012 NHPs going through Full Survey after June 30, 2013. With the change to three Evaluation Options in 2013, what are New Health Plans required to do in their first Full Survey?

Beginning July 1, 2013 New Health Plans will be required to undergo the Renewal Evaluation Option in their first Full Survey. Prior to June 30, 2013, New Health Plan will undergo the Initial Survey as their first Full Survey. The look-back period for the survey will be 12 months.

10.15.2012 Standards If some factors are not applicable for our case management program, how would we address it to meet the requirements in CM 2, Element E: Initial Assessment?

For CM 2, Element E, which is a file review element, NCQA is looking for documentation of whether or not you completed the applicable activities listed in CM 2, Element D: Initial Assessment Process. For your program, you would note in your documentation that certain factors are not applicable for that particular patient population.

10.15.2012 Standards Does NCQA require specific certifications for organization staff?

While NCQA does not include in requirements that your staff to hold specific certifications for case management, NCQA does have standards requiring organizations to verifying licensure for clinical staff who are required to maintain a license. "Clinical staff" is defined as individuals who are licensed to treat patients. Organizations would determine which certifications are appropriate for staff serving their patient population.

CM 2014

10.11.2012 Submission of NCQA WHP Performance Measures When must organizations submit NCQA WHP Performance Measures in order to obtain Accredited With Performance Reporting (AWPR) status?

Organizations coming through the WHP accreditation process for the first time and that wants to earn AWPR status must submit audited measures with the ISS Survey Tool submission. Organizations with current AWPR status must submit measures on April 15 to maintain the AWPR status. Organizations that do not submit performance measures with their Survey Tool can apply for an upgrade to AWPR status at the next annual submission date (the April 15 following receipt of accreditation status).

WHP 2013

9.16.2012 General Guidelines Can an organization continue to collect medical records for members in the hybrid sample after the May 15 medical record review deadline and record them in supplemental database for use in the current reporting year?

No, organizations may not continue to collect medical record data past May 15 and enter it into a supplemental database for use in the current HEDIS year.

HEDIS 2013

9.16.2012 Cervical Cancer Screening The USPSTF released new recommendations for cervical cancer screening in March 2012. It recommends cytology (Pap test) screening every three years for women 21_65 years of age or, for women 30_65 years of age who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every five years. In light of the new recommendations, will NCQA update the CCS measure to account for the lengthened screening for women 30_65 years?

In response to USPSTF recommendations, NCQA has scheduled the CCS measure for reevaluation in 2012. The appropriate staff and panels will review updates and other relevant guidelines and will evaluate potential changes to the measure. Proposed changes, if any, will be posted for Public Comment in February 2013 and, pending final approval by the NCQA Committee on Performance Measurement, will be included in HEDIS 2014.

HEDIS 2013

9.16.2012 Medication Reconciliation Post-Discharge The Medication Therapy Management (MTM) program is required for CMS Parts C and D data validation audits. May we use data from the MTM program to satisfy the "medication reconciliation" requirements in the MRP measure?

Data from the MTM program may be used only if the organization can distinguish a member's discharge medications from the member's current medications. The reconciliation must have occurred on or within 30 days of discharge by a prescribing practitioner, clinical pharmacist or registered nurse to meet the intent of the measure.

HEDIS 2013

9.15.2012 "In-print" format Is including a "print" option in an online document enough to meet NCQA's "in print" requirement?

No. By "in print," NCQA means a printed copy of a document that is made available (e.g., by mail) to eligible individuals who may not have access to the Internet.

9.15.2012 Basics What are the benefits for completing the Exchange Add-on Survey?

1. Allows you to market your Exchange product as NCQA Accredited to Exchanges and potential members.

2. Allows you to meets Exchange accreditation requirements, for those Exchanges that require Exchange _specific Accreditation.

3. Its a streamlined and efficient process, where plans need to attest that they will operate their Exchange the same as their accredited product. Unless there are many differences, NCQA will not review further documentation.

9.15.2012 Contact Information Who can I contact if I would like to learn if the Exchange Add-on Survey is the correct path for my plan?

Ledia Tabor, Director of Quality Solutions Group (Exchanges) at Tabor@ncqa.org or 202-995-1725.

Jennifer Zutz, Analyst of Quality Solutions Group (Exchanges) at Zutz@ncqa.org or 202-955-1720.

9.15.2012 Basics What happens after the Exchanges Add-on Survey accreditation status expires?

The Exchange Add-on accreditation status is valid until your existing NCQA accredited product expires. Once this occurs, you must bring your Exchange product through the Renewal Evaluation Option which would include submission of HEDIS and CAHPS results starting in 2015.

9.15.2012 Pricing What is due at the time of the application submission?

Application submission fee is $10,000. Organizations should use the Invoice and Payment Information Form included in the application packet to generate their own invoice for the application fee.