FAQ Directory: Wellness and Health Promotion

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5.01.2015 Notifying NCQA of Reportable Events How and when must the organization notify NCQA of 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. 

WHP 2013

5.01.2015 Reporting Regulatory Actions Are health plans required to report regulatory actions taken against the organization?

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.

WHP 2013

1.15.2015 Applying First Survey requirements to organizations coming through WHP Certification for the first time If an organization is certified in HAs or Self-Management Tools under the HIP Standards and Guidelines and is coming through for certification under the WHP standards and guidelines, is it held to Renewal Survey requirements for WHP 3 and WHP 13 (new requirements for certified organizations)?

No. These organizations are held to Initial Survey requirements for the WHP 3 and WHP 13 standards.

WHP 2014

10.15.2014 NA for certification program Does WHP 13, Element E (which requires annual measurement of the effectiveness of two actions addressing improvement opportunities) apply to organizations previously certified in health appraisals or self-management tools under the HIP Standards and Guidelines?

No. NCQA will score this element NA for organizations coming through for NCQA Certification for the first time under the 2014 WHP Standards and Guidelines.

WHP 2014

10.15.2013 Use of a vendor or delegate for HIP and WHP Certifications. May an organization coming through for HIP or WHP certification use a vendor or delegate for any functions or activities required by the standards and guidelines?

No. Organizations coming through for NCQA HIP or WHP Certification may not use a vendor or delegate for any functions or activities required by the HIP/WHP certification standards and guidelines.

WHP 2013

8.29.2013 NCQA Complaint Review Process Does the Authorization NCQA receives from the complainant permit the organization to release information to NCQA and NCQA to the organization?

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.

WHP 2013

8.29.2013 NCQA Complaint Review Process Are complaints sent to a specific person at an organization?

Yes. Complaints are forwarded to the organizations Accreditation contact.

WHP 2013

8.29.2013 NCQA Complaint Review Process When does the 30 calendar-day response period begin?

The time period for response begins when the health plan receives the complaint from NCQA.

WHP 2013

8.29.2013 NCQA Complaint Review Process Does our current Agreement with NCQA permit NCQA to investigate complaints?

Yes, the current Agreement allows NCQA to investigate complaints relevant to the standards.

WHP 2013

8.29.2013 NCQA Complaint Review Process Does NCQA expect the organization to release peer-related information?

This is up to the organization, in conjunction with their legal counsel, if disclosure is permitted. The organization is expected to provide a copy of the response given to the complainant to NCQA.

WHP 2013

8.29.2013 NCQA Complaint Review Process Is the NCQA Complaint Review Process dated March 25, 2013 new?

No, this is not a new process or policy. NCQA has followed this process for handling complaints for more than a decade. In the interest of transparency, NCQA is sharing its policy with organizations.

WHP 2013

11.15.2012 WHP Performance Measure Reporting What is the process for reporting performance measure results for Accredited With Performance Reporting (AWPR) status?

Organizations are responsible for reporting NCQA WHP performance measure results exactly as specified if they are seeking AWPR status. Organizations must submit performance measure results to NCQA and attain a score of 50% or higher on WHP 12, Element A.

In order to retain AWPR status, organizations must annually submit performance measure results. Organizations that are NCQA Accredited in Wellness and Health Promotion and want to upgrade to AWPR status must submit measure results by the next annual reporting date (April 15) in any year during the accreditation cycle.

Organizations typically complete the WHP Performance Measures Reporting Tool, an Excel workbook. They send the workbook to an NCQA-Certified Auditor to have their measure results audited before submission. The auditor completes the audit worksheet in the Reporting Tool and locks the workbook, the returns the workbook to the organization, which subsequently submits the tool to NCQA.

WHP 2013