Case Management Accreditation assesses an organization’s performance in the following key areas:
- Identification and assessment
- Care planning
- Care monitoring
- Care transitions
- Measurement and quality improvement
Yes. The Agreement for Health Plan Accreditation Survey (the “Agreement”), specified in the “Organization’s obligations” section of the standards and guidelines, requires the organization to provide NCQA written notice within thirty (30) calendar days of the final determination by a state or federal agency with respect to request for corrective action, imposition of sanctions, changes in licensure or qualification status, if applicable, or violation of any federal or state law that affects the Scope of Review under the Standards and Guidelines. These are termed Reportable Events.
The organization must notify NCQA, in writing, within thirty (30) calendar days of the issuance of the notice of sanctions, issuance of a fine or issuance of a request for corrective action.
The organization must also complete an annual attestation signed by an officer, or other authorized signatory of the organization, affirming that it has notified NCQA of all Reportable Events specified within the Agreement. NCQA-accredited health plans that reports HEDIS results include the attestation with its submission of the annual IDSS attestation submission for HEDIS® reporting. Other health plans submit the completed attestation electronically to NCQA-Accreditation@ncqa.org.
The organization must report the occurrence of any of the following actions by any federal or state regulatory authority:
The above actions are referred to as the “final determination” within the Agreement.
Yes. Release of information to the organization by NCQA and the organizations release of information to NCQA is covered. The organization is not required to seek subsequent release from the member/complainant because the authorization form covers both entities. However, the organization is free to seek their own authorization should they choose to do so.