FAQ Directory: Health Plan Accreditation

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2.15.2023 Recent updates to the MA Deeming Module NCQA updated the 2023 Medicare Advantage (MA) Deeming Module to incorporate changes mandated by the Bipartisan Budget Act of 2018 and as codified in the January 2021 Part C and D final rule. Do these changes apply to the 2022 MA Deeming Module?

Yes. The following changes apply to the 2022 MA Deeming Module:

  • MA 19, Element A:
    • Clarified that the organization’s delegation agreements for MA standards must include a statement requiring delegates to adhere to MA regulations.
  • SNP 2, Element A:
    • Revised factor 3 to reference both initial and annual health risk assessments (HRAs).
    • Clarified in the explanation that the organization must conduct an initial and annual HRA using a comprehensive HRA tool and ensure that results are addressed in the member’s individualized care plan, as required under 422.101(f)(1)(ii).
  • SNP 2, Element C:
    • Added factor 2: “The organization annually, and within the first 12 months of enrollment, conducts face-to-face encounters between the member and their care team.” The face-for-face encounter must be either in person or through visual, real-time, interactive telehealth.
    • Adjusted the scoring to reflect the new factor.
    • Revised the explanation to include “Factor 2: Face-to-face encounter” subhead and text. The encounter must be between the member and representative from any of the following:
      • The ICT.
      • The organization’s case management and coordination staff.
      • A health care provider contracted with the health plan.
  • SNP 3, Element A:
    • Revised factor 5 to read: “Including the ICT, as outlined in SNP 2, Element C, to oversee the MOC’s evaluation and monitoring process.”
    • Revised the scope of review to clarify that the organization includes the ICT in the monitoring and evaluation process.
    • Replaced the “Factor 5: Appropriate personnel” subhead with “Factor 5: The ICT” and revised the explanation to read:
      • The organizational chart documents the organization’s reporting structure and staff responsible for administering the MOC program, including the ICT, as specified in SNP 2, Element C, factor 1. According to the defined MOC, the organization must use an ICT to manage member care. The ICT includes:
        • Practitioners with demonstrated expertise and training,
        • Training in a defined role appropriate to their licensure in treating individuals similar to the targeted population of the organization, as applicable.

HP 2022