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FAQ Directory: Health Information Products

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8.15.2019 Policy Update regarding must-pass elements and the status modifier “Under Corrective Action” NCQA posted an update for PHP 2019, CVO/HIP/WHP/DM 2016 and PHQ 2013 that stated, “If an organization does not meet the must-pass threshold for any must-pass element, a status modifier of ‘Under Corrective Action’ will be displayed after the applicable accreditation status (e.g., Accredited/Certified—Under Corrective Action) until NCQA confirms that the organization has completed the Corrective Action Plan (CAP).” Is NCQA changing the policy for these products, which has been that if an organization fails to meet the must-pass threshold, it is denied Accreditation or Certification?

No. This policy update was made in error and will be corrected in November 2019 for the products listed. An organization will be denied Accreditation or Certification if it fails to meet the must-pass threshold for specified requirements in those products.

HIP 2013

9.15.2015 Acceptable Documents for Policies and Procedures Many scopes of review in the standards require policies and procedures. How does NCQA define “policies and procedures” and what are acceptable documents?

Policies and procedures are official documents that describe business rules and a course of actions, and the methods for carrying out the actions. Simply put, policies and procedures specify how an organization performs the requirement under review—the organization’s “documented process.”
Usually, NCQA expects the organization to present only the components of the policies and procedures that demonstrate it meets the requirement. Depending on the element, this may include, but is not limited to, a program description, operating guidelines or process flowchart. 

 

HIP 2013