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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7.15.2021 Use of Mail Service Organizations for Distribution Requirements Is it considered delegation if an organization uses a mail service organization to meet distribution requirements?

NCQA considers it to be delegation if the organization uses another organization, including a mail service organization, to perform any function not listed in the “Vendor” section of Appendix 2. 
NCQA considers it to be a vendor relationship if the organization uses another organization (e.g., a mail service organization) to perform functions evaluated by the elements or element components listed in the "Vendor" section of Appendix 2.

HP 2021

7.15.2021 Use of Mail Service Organizations for Distribution Requirements Is it considered delegation if an organization uses a mail service organization to meet distribution requirements?

NCQA considers it to be delegation if the organization uses another organization, including a mail service organization, to perform any function not listed in the “Vendor” section of Appendix 3. 
NCQA considers it to be a vendor relationship if the organization uses another organization (e.g., a mail service organization) to perform functions evaluated by the elements or element components listed in the "Vendor" section of Appendix 3.

MBHO 2021

7.15.2021 Virtual-Only Practitioners If an organization wants to add virtual-only practitioners to its network for services such as behavioral health, does that affect NET 5 and CR 1?

Yes. If an organization adds virtual-only practitioners to its network, the provider directory must indicate that such practitioners are virtual only (i.e., in lieu of a physical office location) to meet NET 5, Element A. Virtual-only practitioners must also be fully credentialed, per requirements in CR 1, Element A.

HP 2021

6.29.2021 July 2021 Summary of Updates What changes were made to the PCMH Standards and Guidelines in Version 7?

Topic Update Highlights
Policies and Procedures Added a section on Natural Disasters and Cybercrime.
Policies and Procedures Updated policy on eligibility to clarify that organizations that operate entirely remotely are eligible.
Appendix 2 – Glossary Added an entry on Behavioral Health Care Clinician.
TC 08/BH 01 Added a note to the guidance language to clarify the required qualifications of a Behavioral Health Care Manager.
KM 20/BH 13 Updated the list of CDS examples in the guidance language.
AC 04 Added language to the guidance to clarify that patient inquiries regarding prescription refills or appointment requests are not considered clinical advice.
CM 06 Updated guidance language to detail how Person-Driven Outcome goals can be used to meet the criteria.
QI 01/ QI 02 Measures data must be input from the new ‘Measures Reporting’ tile of the Organization Dashboard.
Appendix 5 Redesigned Appendix 5 to outline measures reporting including a table of standardized measures now supported.
Distinction in Behavioral Health Integration Clarified that already Recognized practices seeking Distinction have one virtual review.

PCMH 2017

6.29.2021 July 2021 Summary of Updates What changes were made to the PCSP Standards and Guidelines in Version 4?

Topic Update Highlights
Policies and Procedures Added a section on Natural Disasters and Cybercrime.
Policies and Procedures Updated policy on eligibility to clarify that organizations that operate entirely remotely are eligible.
KM 17 Updated the list of CDS examples in the guidance language.
AC 02 Added language to the guidance to clarify that patient inquiries regarding prescription refills or appointment requests are not considered clinical advice.
PM 11 Updated guidance language to detail how Person-Driven Outcome goals can be used to meet the criteria.
QI 01 A, B and C Measures data must be input from the new ‘Measures Reporting’ tile of the Organization Dashboard.

PCSP 2019

6.15.2021 General Guideline 31 Is data from a certified eCQM vendor considered standard supplemental data?

No. NCQA released a policy change in July 2020 stating that certified QRDA I files are not considered standard supplemental data for HEDIS® reporting in 2022 for HEDIS MY 2021. Because of the dual HEDIS publication, HEDIS MY 2021 Volume 2 did not account for this policy change, but it will be reflected in HEDIS MY 2022 Volume 2. However, this FAQ is a reminder the policy changed in July 2020 and therefore must be followed. Organizations should work with their auditor to have this data validated as nonstandard supplemental data.

 

HEDIS 2021

4.15.2021 Antidepressant Medication Management (AMM) For Effective Continuation Phase Treatment, how many days are counted in the 232-day interval if a prescription of a 90-days supply is dispensed on the 151st day?

Count 82 days in the 232-day interval for a prescription of a 90-days supply dispensed on the 151st day.

**This FAQ applies only to HEDIS Volume 2 MY 2021.

HEDIS 2021

4.15.2021 Persistence of Beta-Blocker Treatment After a Heart Attack (PBH) How many days are counted in the 180-day interval if a prescription of 90 days supply is dispensed on the 100th day?

Count 81 days in the 180-day interval for a prescription of a 90-days supply dispensed on the 100th day.

**This FAQ applies only to HEDIS Volume 2 MY 2021.
 

HEDIS 2021

4.15.2021 Provisional Status Triggers In what circumstances will an organization receive Provisional status?

An organization will receive Provisional status if it:  
 

  1. Scores below 80% and above 55% of the maximum possible points in any Standards Category, or  

  1. Does not achieve an element score of “Met” in three or more must-pass elements.

HP 2020

4.15.2021 Provisional Status Triggers In what circumstances will an organization receive Provisional status?

An organization will receive Provisional status if it:  
 

  1. Has an overall standards score between 60 and 69.99, or  

  1. Does not achieve an element score of 80% in three or more must-pass elements.

MBHO 2021

4.15.2021 Evaluation Options for PHM 6, Element B Does PHM 6, Element B apply to First Surveys?

No. PHM 6, Element B applies only to Renewal Surveys. First Surveys are not required to meet this element and will receive an NA for 2020.

HP 2020

4.15.2021 Vendor Relationship: ME 2, Element A Are all the requirements in ME 2, Element A considered a vendor relationship if the organization utilizes a mail vendor for distribution?

No. For ME 2, Element A, only the distribution component of the requirement is considered a vendor relationship. 

As stated in the explanation, these elements may not be delegated. The organization must create the written information, but may distribute it through a mail vendor.

HP 2021