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Have the allowed methods to audit delegate files in UM 13, Element C, factor 5 changed?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000018992No. Delegate files may be audited using one of the following methods as described in the factor explanation and noted below: 5 percent or 50…
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What is the corrective action process for organizations that do not meet a must-pass element?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000016184A Corrective Action Plan (CAP) is required when an organization does not meet the minimum threshold for one or more must-pass elements. The CAP must…
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NCQA added language to CR 7 in the 2020 Health Plan Accreditation standards to clarify that Element A applies to all organizational providers (e.g., telemedicine providers, urgent care centers). What
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000015656NCQA added the word “all” to CR 7 in the 2020 HPA standards and guidelines because it expects organizations to have policies for assessing all…
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Has NCQA issued guidance about exceptions or modifications to NCQA programs and requirements in response to the coronavirus?
ncqa.org/programs/health-plans/behavioral-health-accreditation/faq/all/?faq=000014909Yes. NCQA posted guidance for HEDIS reporting and Accreditation/Recognition programs at https://www.ncqa.org/covid/. NCQA is monitoring the effects of the coronavirus on our customers; we will…
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Is there a resource that outlines the 2020 HPR methodology, including the list of HEDIS and CAHPS measures required for Accreditation?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000014073The structure of Accreditation scoring is changing, beginning with Health Plan Accreditation 2020 and the 2020 HEDIS reporting year, when Accreditation and Health Plan Ratings…
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The UM 5, Elements A, C, E timeliness requirements were retired in 2020 Health Plan Accreditation. These requirements will be scored NA in HPA 2019. How will this affect timeliness reporting in UM 5,
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000013795An “NA” score for UM 5, Elements, A, C and E will not affect the review of UM 5, Element G: UM Timeliness Report. However,…
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The UM 5, Elements A, C, E timeliness requirements were retired in 2020 Health Plan Accreditation. These requirements will be scored NA in HPA 2019. Does that mean that the “Explanation” and the “Rela
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000013798No. The “Explanation” and the “Related information” sections of UM 5, Elements A, C and E still apply to UM 5, Elements B, D and…
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What is the Health Plan Medicaid Module?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000012347NCQA Health Plan Medicaid Module is a complementary program designed to support NCQA-Accredited health plans with a Medicaid product line. The combination of the module…
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How do I get started with Wellness and Health Promotion Accreditation/Certification?
ncqa.org/programs/health-plans/wellness-and-health-promotion-whp/faqs/faq-directory-wellness-and-health-promotion/?faq=000012386If you are not currently Accredited or Certified and are interested in learning more, contact NCQA. If you are currently Certified and want to talk to…
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How do I get started with MBHO Accreditation?
ncqa.org/programs/health-plans/behavioral-health-accreditation/faq/all/?faq=000012344If you are not currently accredited and want to learn more, contact NCQA. If you are currently accredited and want to talk to someone about…
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What is the process for meeting Module requirements?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000012351The first step is a discussion with an NCQA program expert. Purchase and review the program resources, conduct a gap analysis and submit your online…
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How do I get started with LTSS Distinction for Health Plans?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000012332If you are not currently accredited and want to learn more, contact NCQA. If you are currently accredited and want to talk to someone about…