FAQ Directory: Managed Behavioral Healthcare Organization Accreditation

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10.15.2018 80% must-pass threshold for UM elements Because NCQA raised the UM must-pass threshold from 50% to 80%, will NCQA create an 80% scoring option for requirements without such a scoring option?

No. To keep scoring simple, NCQA set a threshold of 80% or higher for all UM must-pass elements, rather than setting a specific threshold for each element based on its scoring options. If an element does not have an 80% option, the “or higher” applies. Keep in mind that an organization may miss the requirements for a few files and still score 100% on the element. For additional information on file review scoring, refer to the scoring table in each element or to the file review worksheet in the Interactive Review Tool (IRT).

MBHO 2019

9.15.2018 Life-planning activities for Complex Case Management (CCM) Policies and Assessment Are organizations required to address life-planning activities at the first contact and start of the CCM initial assessment?

No. After consideration, NCQA removed the requirement for case managers to address life-planning activities at the start of the initial assessment (first contact). This FAQ replaces the previous FAQ issued on October 15, 2017 (which has been deleted) regarding first contact, and the workbook has been adjusted to accommodate the change.

MBHO 2019

9.15.2018 Terminated arrangements more than 90 calendar days before submission If an organization terminated an arrangement with an NCQA-Accredited/Certified/Recognized delegate more than 90 calendar days before it submitted the completed survey tool, is the organization eligible for automatic credit for the portion of the look-back period when activities were performed by the delegate?

Yes. For non-file review requirements, if the arrangement was terminated more than 90 calendar days before submission of the completed survey tool, the organization is eligible for automatic credit for the portion of the look-back period when the NCQA-Accredited/ Certified/Recognized delegate conducted activities. For file review requirements, automatic credit is applied if the delegate processed (or handled) the file, regardless of when the delegation arrangement was terminated.

MBHO 2019

8.24.2018 What is the process for earning Managed Behavioral Healthcare Accreditation?

The first step to earning accreditation is a discussion with an NCQA program expert. Purchase and review the program resources, conduct a gap analysis and submit your online application.
Align your organization’s processes with the CR standards. NCQA conducts the survey and determines your accreditation status within 30 days of the final review.
See a step-by-step process.

MBHO 2019

8.24.2018 How do I get started with MBHO Accreditation?

If you are not currently accredited and want to learn more, contact NCQA. If you are currently accredited and want to talk to someone about your status or about renewing or adding accreditations, submit a question through My NCQA.

MBHO 2019

8.24.2018 Where can I find information to help me get started with MBHO Accreditation?

8.24.2018 What other organizations have earned Managed Behavioral Healthcare Accreditation?

More than 30 organizations have earned NCQA Health Plan Accreditation. See the NCQA Report Card for a directory of accredited organizations.

MBHO 2019

8.24.2018 How long does it take to earn Managed Behavioral Healthcare Accreditation?

The typical evaluation time frame is 12 months from application submission to decision, depending on an organization’s readiness. Some organizations may already be working within NCQA guidelines.

MBHO 2019

8.24.2018 What is the price for Managed Behavioral Healthcare Accreditation?

Pricing is based on multiple factors. Obtain full pricing information by submitting a request through My NCQA.

MBHO 2019

8.24.2018 What organizations are eligible for Managed Behavioral Healthcare Accreditation?

Any organization that provides managed health care services may apply for the NCQA Managed Behavioral Healthcare Organization Accreditation if it meets the following criteria:

  • Has been in operation for at least six months, and
  • Enrolls or receives enrollment of an identifiable eligible population that is eligible to access the network, and
  • Provides comprehensive behavioral health care services through an organized delivery system across a continuum of care, and
  • Performs functions addressed in the standards (quality improvement, care coordination, utilization management, credentialing, member rights and responsibilities), either directly or through a service agreement, and
  • Has a process for monitoring, evaluating and improving the quality and safety of care.

MBHO 2019

8.24.2018 Where can I find the MBHO Standards and Guidelines?

8.24.2018 What are Managed Behavioral Healthcare Accreditation requirements?

The standards, provide a framework for implementing best practices to improve:

  • Quality Management and Improvement: Monitor, evaluate and improve the quality and safety of care.
  • Care Coordination: Coordinate medical care and behavioral healthcare for its members.
  • Utilization Management: Notifies members and practitioners about coverage decisions within required time frames.
  • Credentialing and Recredentialing: Verifies the credentials of the practitioners in its network.
  • Members’ Rights and Responsibilities: Written members’ rights and responsibilities policy exist.

To see the program requirement details, get the Standards & Guidelines document.

MBHO 2019