Yes. Plans that notify NCQA that they want to be scored on HEDIS/CAHPS measures by December 31 (before the June HEDIS reporting date) may score higher than Accredited status.
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8.15.2012 Evaluation Options: Status and Scoring Is it possible for plans to score higher than Accredited status during any First Evaluation Option years?
8.15.2012 Evaluation Options: Status and Scoring Will currently accredited plans be scored 50 points for HEDIS/CAHPS and 50 points for standards?
8.15.2012 Evaluation Options: Accreditation Surveys How do plans add an Exchange accreditation to an existing accreditation?
Plans submit an application identifying whether their Exchange product will be operated the same as the accredited product. If 70 percent of the Interim Evaluation Option elements are the same, the Exchange product line receives automatic accreditation under the plans accreditation. If the majority of the operations are not the same, plans undergo a streamlined Add-On Survey with a six-month look-back period.
This applies to the following Programs and Years:
8.15.2012 Evaluation Options: Eligibility How long must a plan be in operation before applying for NCQA Accreditation?
Plans may apply for the Interim Evaluation Option and the First Evaluation Option at any time, regardless of how long they have been in operation.
For the Interim Evaluation Option, plans must show evidence that they met the requirements before the survey start date.
For the First Evaluation Option, plans must show that they met the requirements for the six months before their survey date.
This applies to the following Programs and Years:
8.15.2012 Evaluation Options: HEDIS Reporting and Scoring Will NCQA review and score HEDIS/CAHPS measures if a plan submits them for the Interim Evaluation Option?
8.15.2012 Evaluation Options: Basics How are the First Evaluation Option and the Renewal Evaluation Option different?
The First Evaluation Option is for plans without existing NCQA Accreditation, and plans may, but are not required to report HEDIS/CAHPS until the third annual HEDIS reporting cycle. HEDIS/CAHPS reporting and scoring are required at the time of survey submission and annually thereafter for the Renewal Evaluation Option.
This applies to the following Programs and Years:
8.15.2012 Evaluation Options: Accreditation Surveys May a plan that was denied accreditation reapply for accreditation in less than a year from the date of the Denied status?
Yes, a plan may apply for a new Accreditation Survey (called an Expedited Survey) in less than a year under specific circumstances, including:
The plan was denied accreditation under the Interim Evaluation Option and may reapply after three months.
The organization demonstrates to NCQAs satisfaction that the issues identified in the original survey can be corrected within a six- to nine-month time frame as a result of the organizations activity.
Correction of the issues would raise the organizations accreditation status in a new survey.
To qualify for an Expedited Survey, a plan must submit a written request listing the steps it has taken to address the substantive issues that led to its Denied Accreditation status.
This applies to the following Programs and Years:
8.15.2012 Evaluation Options: Standards and Guidelines To which product lines and evaluation options do the Member Connections (MEM) standards apply?
8.15.2012 Evaluation Options: HEDIS Reporting and Scoring Are HEDIS/CAHPS measures reported during the third annual HEDIS reporting cycle scored for the First Evaluation Option?
8.15.2012 Evaluation Options: HEDIS Reporting and Scoring When must plans report HEDIS/CAHPS measures if they are going through the First Evaluation Option?
8.15.2012 Evaluation Options: Standards and Guidelines Several elements in the First Evaluation Option require annual evaluation, even though the Evaluation Option has a six-month look-back period for all other elements. How do plans meet this annual requirement?
NCQA will expand the look-back period if it is necessary for plans to demonstrate that performance requirements are met and to produce an adequate sample for file reviews. For annual requirements, plans must complete the activity at least once during the prior year.