NCQA Seeks Public’s Help for Updates to Health Plan Accreditation for 2018

Public Comment is Open March 6–April 4

March 6, 2017

WASHINGTON, DC—The National Committee for Quality Assurance (NCQA) invites the public to comment on updates to Health Plan Accreditation (HPA) for the standards year 2018. Each year, NCQA opens a public comment period for accreditation products updates. The public comment period helps NCQA create better products by inviting customers and stakeholders to provide feedback.

Updates to HPA 2018 that focus on three key topic areas:

  1. NEW Population Health Management (PHM) standards category
  2. Changes related to CMS’s Medicaid Managed Care Final Rule
  3. Survey process changes to element UM 4H: Appropriate Classification of Denials

Details of Proposed HPA 2018 Changes:

1.   Population Health Management (PHM)

This NEW category will:

  • Help health plans set and achieve population health management goals.
  • Create better coordination from health plans to other entities in the delivery system. The requirements allow organizations the flexibility to achieve PHM goals through a variety of delivery system arrangements.
  • Meet the Triple Aim. The requirements allow plans to focus on achieving the Triple Aim: better care, lower costs and improved health.
  • Refocus from evaluation of siloed programs to a whole-person approach, recognizing the many factors affecting member health. This includes creating new standards, transforming standards from the Quality Management and Improvement (QI) and Member Connections (MEM) categories and eliminating QI 6: Disease Management, QI 7: Practice Guidelines and MEM 7: Support for Healthy Living.

The NCQA Advantage: Population health management sets the stage for comprehensive health care that meets the needs of all individuals along their care journey. The PHM category helps health plans create a PHM strategy and assure other stakeholders, such as employers and consumers, that they consider and coordinate all aspects of care.

2.   Medicaid Managed Care Rule Updates

Requirements will be updated to align with the CMS Medicaid Managed Care Final Rule, allowing Medicaid plans to follow one set of requirements to meet both federal regulations and accreditation requirements.

The NCQA Advantage: By aligning the current set of standards with MMC, NCQA intends to reduce burden to Medicaid plans so they can use resources where they are most needed: on beneficiaries.

3.   UM 4H Updates

NCQA requests feedback on two proposed options for surveying Element UM 4H: Appropriate Classification of Denials.

The NCQA Advantage: Acting on feedback received about this element, NCQA wants to work with stakeholders to improve the requirement. Transparency and direct response assures health plans and stakeholders that NCQA listens and strives to improve.

How to Participate in Public Comment

Read and comment on the proposed changes online:

The Public Comment period begins at 8 a.m. ET on March 6 and ends at 5 p.m. ET on April 4. Updated products will be released in July.

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