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FAQ Have the allowed methods to audit delegate files in UM 12, Element C, factor 5 changed?
ncqa.org/programs/health-plans/managed-behavioral-healthcare-organizations-mbho/faqs/all/?faq=000018993No. Delegate files may be audited using one of the following methods as described in the factor explanation and noted below: 5 percent or 50…
FAQ 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…
FAQ Have the allowed methods to audit delegate files in CR 8, Element C, factor 5 changed?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000018994No. Delegate files may be audited using one of the following methods as described in the factor explanation and noted below: 5 percent or 50…
FAQ 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…
FAQ 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…
FAQ Has NCQA issued guidance about exceptions or modifications to NCQA programs and requirements in response to the coronavirus?
ncqa.org/programs/health-plans/managed-behavioral-healthcare-organizations-mbho/faqs/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…
FAQ 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…
FAQ 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,…
FAQ 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…
FAQ 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…
FAQ Where can I find information to help me get started with Health Plan Accreditation?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000012312Accreditation Process and Timeline:Key steps, timing and resources for a successful accreditation.Standards and Guidelines: The complete standards and guidelines, including the intent and scope of…
FAQ What organizations are eligible?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000012328An organization is eligible for the NCQA LTSS Distinction for a product/product line if: The product/product line has a current NCQA Accreditation status, orThe product/product…