ncqa update - 2014

All materials © 2012, National Committee for Quality Assurance

NCQA Update - 2014

National Credentialing ForumFebruary 6, 2014

2NCQA UpdateFebruary 6, 2014

EXCHANGES

3NCQA UpdateFebruary 6, 2014

Federally-Facilitated Exchanges: Requirements Phase in

Certification Year QHP issuers without

existing accreditation

QHP Issuers with existing Commercial,

Medicaid accreditation for the

state

Year 1 (2013) Schedule accreditation review

Attest that accredited policies and procedures are comparable to Exchange (not all the same)

Years 2 and 3 (2014-2015)

Be accredited for Exchange product (policies and procedures)

Attest that accredited policies and procedures comparable to Exchange

Year 4 (2016) Exchange product is accredited, performance data submitted

4NCQA UpdateFebruary 6, 2014

HPA 2013 - 2014EVALUATION OPTIONS

5NCQA UpdateFebruary 6, 2014

What is an Evaluation Option?

• An Evaluation Option is defined by its distinct combination of:– Requirements (standards and measures)– Scoring– Statuses– Length of accreditation

6NCQA UpdateFebruary 6, 2014

Three Evaluation Options

Evaluation Option

Eligibility Duration Scope

InterimUnaccredited plans 18 months

Policy/Procedures (prior to survey look back period)No file review

First Unaccredited plans 36 months

Policy/Procedures and evidence of implementation (6 month look back)

RenewalPlans with NCQA Accreditation

36 months

Policy/Procedures and evidence of implementation (24 month look back)

7NCQA UpdateFebruary 6, 2014

How Measures and Scoring Fit In

Evaluation Option

Measure Requiremen

ts

Maximum Point

Allocation

Maximum Status

Interim Not Required Standards—50 points Interim

First Optional

Standards—50 points

Accredited

Standards—50 pointsHEDIS—37 pointsCAHPS—13 points

Excellent

Renewal Required

Standards—50 pointsHEDIS—37 pointsCAHPS—13 points

Excellent

8NCQA UpdateFebruary 6, 2014

So what’s happened

• NCQA has accredited XXX Exchanges

• Were accredited under the Interim standards or as an “Add-on” to currently accredited plans

• Those with Interim status will be coming through First Evaluation Option at the end of December 2014 and 2015.

9NCQA UpdateFebruary 6, 2014

CREDENTIALING UPDATE 2014

10NCQA UpdateFebruary 6, 2014

CR 3: Credentialing Verification• Added

– Factor 4: Verification of board certification status, if applicable.

• Documentation– No new requirements

• Rationale– Allows separate verification of boards that

cannot be used to meet E & T requirement.– Allows for verification of certification for

recertification.

11NCQA UpdateFebruary 6, 2014

Possible Change in 2016 • Adding the following for Exchanges

– Essential Community Providers (ECP) • Providers with experience caring for medically

underserved populations.• Include community health clinics, Ryan White

HIV/AIDS providers, Family Planning Providers (Title X Family Planning Clinics), Indian Providers and safety-net hospitals (hospitals that receive disproportionate Share Hospital funding), STD Clinics, TB Clinics, Hemophilia Treatment Centers, Black Lung Clinics.

• Go to https://data.cms.gov/dataset/Non-Exhaustive-List-of-Essential-Community-Provide/ibqy-mswq for a full list.

12NCQA UpdateFebruary 6, 2014

Possible Change in 2016 • Adding the following for Exchanges

– Children’s Dental Services• Currently only oral surgeons are included in NCQA

credentialing requirements.• May need to add dentists who treat children in future.