FAQ Directory

Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can  ask a question through My NCQA.

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6.29.2021 July 2021 Summary of Updates What changes were made to the PCSP Standards and Guidelines in Version 4?

Topic Update Highlights
Policies and Procedures Added a section on Natural Disasters and Cybercrime.
Policies and Procedures Updated policy on eligibility to clarify that organizations that operate entirely remotely are eligible.
KM 17 Updated the list of CDS examples in the guidance language.
AC 02 Added language to the guidance to clarify that patient inquiries regarding prescription refills or appointment requests are not considered clinical advice.
PM 11 Updated guidance language to detail how Person-Driven Outcome goals can be used to meet the criteria.
QI 01 A, B and C Measures data must be input from the new ‘Measures Reporting’ tile of the Organization Dashboard.

This applies to the following Programs and Years:
PCSP 2019

6.15.2021 General Guideline 31 Is data from a certified eCQM vendor considered standard supplemental data?

No. NCQA released a policy change in July 2020 stating that certified QRDA I files are not considered standard supplemental data for HEDIS® reporting in 2022 for HEDIS MY 2021. Because of the dual HEDIS publication, HEDIS MY 2021 Volume 2 did not account for this policy change, but it will be reflected in HEDIS MY 2022 Volume 2. However, this FAQ is a reminder the policy changed in July 2020 and therefore must be followed. Organizations should work with their auditor to have this data validated as nonstandard supplemental data.

 

This applies to the following Programs and Years:
HEDIS MY 2021

4.15.2021 Antidepressant Medication Management (AMM) For Effective Continuation Phase Treatment, how many days are counted in the 232-day interval if a prescription of a 90-days supply is dispensed on the 151st day?

Count 82 days in the 232-day interval for a prescription of a 90-days supply dispensed on the 151st day.

**This FAQ applies only to HEDIS Volume 2 MY 2021.

This applies to the following Programs and Years:
HEDIS MY 2021

4.15.2021 Persistence of Beta-Blocker Treatment After a Heart Attack (PBH) How many days are counted in the 180-day interval if a prescription of 90 days supply is dispensed on the 100th day?

Count 81 days in the 180-day interval for a prescription of a 90-days supply dispensed on the 100th day.

**This FAQ applies only to HEDIS Volume 2 MY 2021.
 

This applies to the following Programs and Years:
HEDIS MY 2021

4.15.2021 Vendor Relationship: RR 3, Element A Are all the requirements in RR 3, Element A considered a vendor relationship if the organization utilizes a mail vendor for distribution?

No. For RR 3, Element A, only the distribution component of the requirement is considered a vendor relationship. 

As stated in the explanation, these elements may not be delegated. The organization must create the written information, but may distribute it through a mail vendor.

This applies to the following Programs and Years:
MBHO 2021

4.15.2021 Provisional Status Triggers In what circumstances will an organization receive Provisional status?

An organization will receive Provisional status if it:  
 

  1. Scores below 80% and above 55% of the maximum possible points in any Standards Category, or  

  1. Does not achieve an element score of “Met” in three or more must-pass elements.

This applies to the following Programs and Years:
HP 2021, 2020

4.15.2021 Provisional Status Triggers In what circumstances will an organization receive Provisional status?

An organization will receive Provisional status if it:  
 

  1. Has an overall standards score between 60 and 69.99, or  

  1. Does not achieve an element score of 80% in three or more must-pass elements.

This applies to the following Programs and Years:
MBHO 2020, 2021

4.15.2021 Evaluation Options for PHM 6, Element B Does PHM 6, Element B apply to First Surveys?

No. PHM 6, Element B applies only to Renewal Surveys. First Surveys are not required to meet this element and will receive an NA for 2020.

This applies to the following Programs and Years:
HP 2020

4.15.2021 Vendor Relationship: ME 2, Element A Are all the requirements in ME 2, Element A considered a vendor relationship if the organization utilizes a mail vendor for distribution?

No. For ME 2, Element A, only the distribution component of the requirement is considered a vendor relationship. 

As stated in the explanation, these elements may not be delegated. The organization must create the written information, but may distribute it through a mail vendor.

This applies to the following Programs and Years:
HP 2021

3.15.2021 CVO 5, Element A: NTIS Verification Source Is the National Technical Information Service (NTIS) an acceptable verification source for DEA under the 2016 CVO Standards and Guidelines?

No. Effective November 17, 2020, NTIS is no longer an acceptable source to verify a practitioner's DEA certificate. This FAQ was addressed in the 2021 CVO updates on 11/23/2020. Please see https://dea.ntis.gov for more information.

This applies to the following Programs and Years:
CVO 2016

1.15.2021 Transitions of Care (TRC) Volume 2 states that for MY 2021 reporting, the organization may reduce the sample size using the prior year’s audited, product line-specific rate. Which rate should organizations use for sample size reduction?

Organizations may reduce the sample size for the TRC measure based only on the prior year’s audited, product line-specific rate for the lowest rate among all reported TRC indicators.

This applies to the following Programs and Years:
HEDIS MY 2020, 2021

1.15.2021 General Guideline 15 When a member has dual enrollment in Medicaid/Medicare how long must the member be enrolled in Medicare (PFFS or primary Medicare enrollment in another organization) to be removed from the Medicaid product line?

There is no minimum enrollment requirement. Per General Guideline 15, members must meet the measure’s continuous enrollment requirements and be considered dually enrolled based on continuous enrollment criteria or the service date.
Organizations must follow General Guideline 15 with regard to assessing coverage and should review enough data to meet the measure specification requirement.

This applies to the following Programs and Years:
HEDIS MY 2020, 2021