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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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10.12.2018 AC 10 & 11 Does a single clinician practice need to provide a documented process and report for AC 10 and AC 11 as all patients would be on the same panel and always see their selected clinician by default?

No, a single clinician practice may simply attest to having a single clinician. This can be done using the text box option of Q-PASS to receive credit for these criteria.

PCMH 2017

9.15.2018 Data collection for prevention programs for behavioral healthcare for QI 6, Element A, factor 5 For QI 6, Element A, factor 5, are organizations required to have implemented a preventive behavioral healthcare program in order to meet the factor?

No. Element A does not require organizations to implement a preventive behavioral healthcare program. The intent of factor 5 is that organizations collect data to determine if there are behavioral health issues that could be prevented if a program were to be implemented. Organizations collect data to meet Element A. Identifying the opportunity for such a program and implementing it is applicable to Element B.

HP 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.

HP 2019

9.15.2018 Level of Analysis Required for Appointment Accessibility Does the organizational analysis in NET 2, Element A need to be stratified by practitioner type?

No. NCQA does not require the analysis to be stratified by practitioner type.

HP 2019

9.15.2018 Terminated arrangements more than 90 calendar days before submission (CM and CMLTSS 2017) 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.

CM 2017

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.

HP 2019

9.15.2018 Revised Look-back Period for UM 7, Elements C, F, I (factors 2 and 3) In the 2019 HPA Standards and Guidelines, NCQA added a fifth bullet to the factor 2 Explanation and revised the factor 3 Explanation in UM 7, Elements C, F and I. Will NCQA give organizations a grace period for the added information in factors 2 and 3 of UM 7, Elements C, F and I?

The intent of the added language in factors 2 and 3 was to clarify the minimum information required for expedited appeals. NCQA recognizes these are new requirements, and for this reason, has added the following language to the scope of review:

Organizations must implement the changes in factors 2 and 3 for files processed on or after 11/1/18.

NCQA will post an update in December for the 2019 HP publication to reflect this change.

HP 2019

9.14.2018 Risk of Continued Opioid Use In the HEDIS 2019 Volume 2 Technical Specifications, the Risk of Continued Opioid Use (COU) measure includes the Medicare product line; however, this measure was not included in the CMS Reporting Requirements memo for HEDIS 2019. Given this discrepancy, is the COU measure reported by Medicare plans?

The COU measure does include the Medicare product line, and it will be collected in IDSS by NCQA from Medicare plans; however, because it was not included in the CMS Reporting Requirements memo, it is not required to be reported to CMS for HEDIS 2019.

HEDIS 2019

9.07.2018 KM 13 Would the annual UDS report, by which FQHC’s are required to submit data to HRSA, be acceptable to provide as a report?

For FQHCs that are part of a larger organization with multiple practices under the same umbrella, UDS reporting would not meet KM 13 because the data is at the organizational/corporate level. The data for KM 13 must be at the practice level because recognition is at the practice level. An exception to this is for standalone practices whose UDS data is specific to the practice site location.

PCMH 2017

8.29.2018 What is the Health Plan Medicaid Module?

NCQA 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 standards and NCQA Health Plan Accreditation maximize alignment with the Medicaid Managed Care program requirements. This improves a plan’s opportunity to receive a streamlined state compliance review.

NCQA developed the module by analyzing changes to state and federal requirements for the Medicaid Managed Care programs, as outlined in the Medicaid Managed Care Rule.

HP 2020

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

8.24.2018 What organizations are eligible for the LTSS Distinction for Health Plans? What organizations are eligible?

An organization is eligible for the NCQA LTSS Distinction for a product/product line if:

  • The product/product line has a current NCQA Accreditation status, or
  • The product/product line is seeking NCQA Health Plan Accreditation.

Note:  NCQA conducts LTSS Distinction Surveys at the legal-entity level. Organizations undergoing Interim Survey are not eligible for LTSS distinction.

Health plans that coordinate LTSS and do not provide medical or behavioral services are not eligible for this distinction but can earn Accreditation of Case Management for LTSS.
 

HP 2020