Public Comment Now Open for Health Plan Accreditation 2019 Standards

Comment Period Runs from March 5 – April 3, 2018

March 7, 2018

WASHINGTON, DC—The National Committee for Quality Assurance (NCQA) invites the public to comment on the proposed 2019 Health Plan Accreditation standards updates. Public comments are an important part of developing and updating health plan accreditation standards. NCQA reviews every comment and presents results to its advisory groups for deliberation and approval.

The proposed updates aim to strengthen the quality of care provided while removing requirements that may no longer be necessary.

Updates to HPA 2019 Standards Focus Improvements in the Following Areas:

Utilization Management

  • Aligned the timeliness of utilization management decisions requirement with CMS time frames for Medicare and Medicaid plans. This helps avoid unnecessary denials and patient confusion when health plans are unable to obtain needed information. Alignment with CMS also helps reduce health plan burden.
  • Strengthened consumer protections by raising the bar on scoring for file reviews.

Removing redundant requirements

  • Eliminated requirements that can be met by other means or no longer add significant value in the following standard categories: Delegation, Credentialing and Recredentialing, Member Connections and Quality Management. Removing these requirements will help health plans save time during the survey preparation process.

How to Comment

Access the proposed updates here. The public can provide feedback on NCQA’s public comment web site:

How does NCQA determine what is updated?

NCQA receives ongoing health plan and stakeholder feedback. In addition, NCQA works with health plans, employers, state and federal government, provider organizations and consumers to identify what is important to them. In all cases, updates to the Health Plan Accreditation standards aim to strengthen the quality of care provided and reduce requirements that may no longer be necessary.

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