Yes, the following CAQH question meets the intent of the requirement in CR 3, Element C, factor 2:
HP 2023
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.
Yes, the following CAQH question meets the intent of the requirement in CR 3, Element C, factor 2:
HP 2023
Yes. NCQA uses language in the Explanation that organizations may use more general or extensive language to query practitioners about impairment.
Note: This question was previously posted on August 15, 2023 and reevaluated by NCQA. This FAQ answer replaces the previously posted response.
HP 2023
It is acceptable to use larger organization-level documented processes or policies and procedures to meet applicable requirements (e.g., for HE 1, Element A, factor 1) if the entity seeking Accreditation demonstrates that it follows the same processes. However, the entity seeking Accreditation must provide documentation that pertains specifically to its organization for requirements that require action or implementation of such processes (e.g., for HE 1, Element A, factors 2 and 3).
HEA 2023
Yes. The following updates to the Exceptions section language are effective immediately and will be included in a Policy Update in November 2023.
This element is NA if:
Factor 1 is NA for mail service delegates.
Factors 2–6 are NA for Interim Surveys.
Factors 3 and 4 are NA if a mail service delegate distributes information for an element with an annual frequency. The delegation agreement in Element A must outline the frequency for reviewing the delegate’s reports (i.e., annual or semiannual) (UM 13, Element A, factor 4).
Factors 5 and 6 are NA if the delegate only provides cloud-based UM data storage functions and does not provide services that create, modify or use UM data.
Factors 5 and 6 are NA for mail service delegates that:
All bullets must be addressed in a delegation agreement for factors 5 and 6 to be NA.
Factor 6 is NA if the organization did not identify any date modifications or if all identified date modifications met the delegation agreement or the delegate’s policies and procedures.
Note: The strikethrough text indicates changes to the Exceptions section.
HP 2024
Yes. NCQA uses language in the Explanation that organizations may use more general or extensive language to query practitioners about impairment.
Note: This question was previously posted on August 15, 2023 and reevaluated by NCQA. This FAQ answer replaces the previously posted response.
CVO 2022
Yes. Using UM 13: Delegation of UM as an example, the following describes factors that would be considered NA:
UM 13, Element A: Delegation Agreement
UM 13, Element C: Review of the UM Program:
Note: Factor 2 (annual audits): This factor is not scored NA, but the organization may submit the delegate’s timeliness report of mail distribution in lieu of an audit. This must be specified in the delegation agreement.
Update: The strikethrough text is an update to the FAQ posted on October 15, 2022.
UM-CR-PN 2023
Yes, the following CAQH question meets the intent of the requirement in CVO 12, Element A, factor 2 and CVO 13, Element A, factor 2:
CAQH provides additional information regarding what "currently" means that aligns with language in the explanation of CVO 12, Element A, factor 2 and CVO 13, Element A, factor 2 that the organization may use more general or extensive language to query practitioners about impairment.
CVO 2022
An example of expected outcome/prognosis is typically clinically based. Expected outcome/prognosis is what the expected outcome of complying with the care plan would be. You can think about it as if a patient follows all instructions of the care plan what you are expecting to happen (e.g., their A1C/BMI/stroke risk etc. will decrease). Generally, we see practices differentiate treatment outcome/prognosis as a more clinical metric, for instance lowering A1C by 2 points etc.
Treatment goals are more lifestyle choices or outcomes for the patient, such as eating more vegetables or getting enough exercise to be able to walk around the block etc.
All of these elements are incorporated into the care plan: a problem list, expected outcome/prognosis, treatment goals, medication management and a schedule to review and revise the plan, as needed.
PCMH 2017