Plans with NHP accreditation must apply for the Renewal Evaluation Option with a 12-month look-back period.
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8.15.2012 Evaluation Options: Basics Which Evaluation Option should plans with New Health Plan accreditation apply for next?
8.15.2012 Evaluation Options: Basics Which Evaluation Option should plans choose if they have not been accredited by NCQA?
8.15.2012 Evaluation Options: Basics How are the Interim Option and the First Evaluation Option different?
The Interim Evaluation Option has half of the number of elements as the First Evaluation Option, focuses on policies and procedures and is valid for 18 months.
The First Evaluation Option is valid for 36 months and focuses on policies and procedures, initial measurement and analysis of programs and file review.
Plans going through the Interim Evaluation Option can earn Interim status (HEDIS/CAHPS reporting is not required); plans going through the First Evaluation Option can earn either Provisional or Accredited status (if they are not scored on HEDIS/CAHPS).
Reporting is required during the third annual HEDIS reporting cycle for organizations going through the First Evaluation Option, which also gives plans the option to be scored on HEDIS/CAHPS results, allowing them to earn an accreditation status higher than Accredited.
8.15.2012 Evaluation Options: Basics In what order do organizations progress through the Evaluation Options?
For the Interim Evaluation Option: Interim, to First, to Renewal.
For the First Evaluation Option: First to Renewal.
After a plan progresses to the Renewal Evaluation Option, all subsequent surveys will be for that Evaluation Option, unless the accreditation lapses for more than two years.
8.15.2012 Evaluation Options: Basics What is the difference between an Evaluation Option and a survey?
An Evaluation Option is defined by a distinct combination of requirements (standards and measures), scoring, statuses and length of accreditation. Health Plan Accreditation (HPA) 2013 has three Evaluation Options: Interim, First and Renewal. Plans are surveyed under one of the three evaluation options based on eligibility.
NCQA administers seven types of surveys to plans seeking accreditation: Full Survey, Follow-Up Survey, Resurvey, Add-On Survey, Expedited Survey, Corporate Survey and State and Federal Agency Survey.
8.15.2012 Evaluation Options: Basics For which Evaluation Options are organizations eligible if their accreditation has expired?
A plan whose accreditation status has expired or has been withdrawn for less than two years is eligible for the Renewal Evaluation Option with a 24-month look-back period.
A plan whose accreditation expired more than two years ago is eligible for accreditation through the Interim Evaluation Option or First Evaluation Options with a six-month look-back period.
8.15.2012 Evaluation Options: Survey Process Will NCQA conduct onsite surveys (at the health plan) for the Interim 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?
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.