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Health Plan Accreditation 2020: Current Customer FAQ

Are you a health plan that is currently accredited by NCQA/ Here are some common questions about Health Plan Accreditation 2020?

Does my process for renewal change?

No. The overall process for renewing your recognition remains the same. However, for plans that have already earned accreditation, NCQA focused renewal on the implementation of processes and policies. As a result, we reduced the total number of elements you have to provide evidence for at renewal, reducing the amount of paperwork required.

Instead of showing us evidence for all elements, we’ve reduced that to 105 elements. Combined with the retired elements, that’s a 34% reduction compared to what the majority of plans have to show today.

Note: Medicaid plans will still have a reduction in total requirements, but will be required to show evidence so accreditation can still meet some CMS oversight requirements. Please reference the standards for a complete overview of requirements.

In addition, NCQA us enhancing the survey tool and management of documents to make it easier on you.

I currently have a status level of [Excellent, Commendable, Accredited]. What is changing about the status levels?

Today, NCQA has two different ways to look at a health plan’s quality: the status a plan earns as part of accreditation (which can be excellent, commendable, accredited or provisional) and a numerical rating as part of annual Health Plan Ratings released each September. NCQA received feedback that these different methodologies can be confusing for consumers, employers and others trying to discern a health plan’s quality.  In addition, we received feedback that the different statuses weren’t always a clear distinguisher of quality. Learn more here.

As a result, NCQA is using eliminating the “Excellent” and “Commendable” status levels and instead using health plan ratings as a means to distinguish health plan quality. Accredited plans will earn ratings once they submit HEDIS® and CAHPS® reporting and can advertise them with their accreditation. Ratings methodology is very similar to today, where performance measurement (HEDIS) and member experience (CAHPS) make up the ratings. Learn more here.

How long can I use my current status level?

NCQA will switch from status levels (e.g. Commendable, Excellent, Accredited) to star ratings in September 2020. You can use your current seal and level through September 2020, after which you can use an accredited seal with your star rating. For more information about this, view the latest policy update.

Based on my status level today, what star rating should I expect?

Below is a table detailing the projected stars your plan will receive based on your status today. There may be a few outliers, but you should generally expect the following:

Current StatusProjected Stars
Excellent4.5-5.0
Commendable3.5-4.0
Accredited2.5-3.0
Provisional1.0-2.0

Is Health Plan Ratings changing?  

The process and method for Health Plan Ratings are not changing beyond typical year-to-year methodology updates. However, there are two notable changes:

  1. Star ratings: After receiving feedback from consumers and other stakeholders, NCQA is moving from a numerical rating to a star rating. The scale will still be 1-5.
  2. Ratings web site: Right now there is a separate report card for accredited plans and a health plan ratings web site. These are being combined into one report card/directory. This way consumers, employers, states and others can evaluate the quality of plans in one place. The new site will launch September 2020 when star ratings are released.

Learn more about the methodology for Health Plan Ratings.

How do updates to Health Plan Accreditation 2020 impact my HEDIS reporting?  

It will not. If you are already accredited and reporting HEDIS, you will continue to do so on an annual basis. For plans that will be earning a new accreditation (Interim or First surveys), HEDIS will be required to be reported at the first reporting cycle after the first full year of accreditation. Learn more about timing for newly accredited plans.

What elements will be scored by product line?

Starting in 2020, NCQA will report scores for standards by product line instead of averaged across product lines (read more about that here). As part of this change, there are several elements where NCQA will begin collecting and scoring evidence by product line. As a result, plans will need to submit evidence by product line for the following elements:

  • PHM 1, Elements A.
  • PHM 3, Element B.
  • PHM 6, Element B.
  • NET 3, Elements A–C.
  • UM 4, Elements C–E.
  • UM 5, Elements A–C.
  • UM 6, Elements A–C.
  • UM 7, Elements A–I.
  • UM 9, Elements A–D.
  • ME 2, Element A.
  • ME 7, Elements C, E.

This change helps clarify to plans, states and others where areas of concern lie, and helps plans better focus on areas that need improvement.

Is the system changing or will IRT remain the platform?

Yes. IRT will remain the platform. We will be making updates to the application and IRT to help make your experience better.

Will we still be able to do a Virtual Survey?

Yes. In addition, previous eligibility criteria for virtual surveys precluded an organization with multiple file reviews for a particular file review element from conducting a virtual survey. Starting with Health Plan 2020, such plans will be able to proceed with a virtual survey.

Where can I find the Standards & Guidelines?

You can purchase the Standards & Guidelines through the NCQA eStore.

When will the survey tool become available?

You can pre-purchase the survey too now through the NCQA eStore. However, the survey tool will not become available for use until March 2020.

What do I do if I have questions?

If you have any questions, submit them through My NCQA and an NCQA representative will be in touch.

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