Policy Allowances Related to Telehealth

Traditionally, NCQA has not allowed organizations to include practitioners who provide telehealth services when setting availability and accessibility standards or analyzing performance against standards. In response to COVID-19, NCQA will temporarily allow organizations with a look-back period between January 1, 2020 and June 30, 2021, to include practitioners who provide telehealth care, for the requirements in the table below. The table identifies applicable elements in in HP 2019 and 2020; however, guidance also applies to applicable requirements in derivative products (e.g., MBHO, UM-CR-PN).

Standard, Element
NET 1: Availability of Practitioners
BPractitioners Providing Primary Care
CPractitioners Providing Specialty Care
DPractitioners Providing Behavioral Healthcare
NET 2: Accessibility of Services
AAccess to Primary Care
BAccess to Behavioral Healthcare
CAccess to Specialty Care

Organizations may include applicable telehealth practitioners for the entire look-back period. Practitioners must provide services for which there is a permanent telehealth and/or temporary COVID-19 telehealth code based on CMS guidance (https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes). Organizations with Medicaid lines of business may include practitioners who provide paid telehealth services, as defined by the states in which they practice.

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