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, 2022, to include practitioners who provide telehealth care, for the requirements in the table below. The table identifies applicable elements in Health Plan Accreditation (HPA); however, guidance also applies to applicable requirements in derivative products (e.g., MBHO, UM-CR-PN).

Standard, Element
NET 1: Availability of Practitioners		#colspan#
B	Practitioners Providing Primary Care
C	Practitioners Providing Specialty Care
D	Practitioners Providing Behavioral Healthcare
NET 2: Accessibility of Services		#colspan#
A	Access to Primary Care
B	Access to Behavioral Healthcare
C	Access to Specialty Care

Organizations may include applicable telehealth practitioners for the time within the accommodation period, January 2020-June 2022. 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.