changes to ncqa health plan accreditation for 2009 gary j. mihalik, md, mba the mihalik group, llc...
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Changes to NCQA Health Plan Accreditation for 2009
Gary J. Mihalik, MD, MBAThe Mihalik Group, LLC1300 W. Belmont #500Chicago, IL 60657www.themihalikgroup.com
Objective
To highlight the most significant changes to NCQA’s Health Plan Accreditation Standards for 2009
General Observations: HPA 2009
No new standards addedNo standards removedMost changes are “clarifications” although
some are significantStandards now constitute 57 out of the 100
points used to determine accreditation status Down from 61.3 points in 2008
QI 9: Clinical Practice Guidelines
QI 9A: CPGs must be in place 24 months or longer at time of survey
This will require that the process for review and update, specified in Factor 3, be implemented
MEM 1: Health Risk Appraisals
MEM 1F: HRA must be available by a means other than on-line
Printed HRAs must contain the same content as the web-based version, including follow-up resources
MEM 4: Pharmacy Benefit Info
MEM 4A and 4B: Use of a PBM is considered delegation All requirements of MEM 9 (Delegation) apply
MEM 4C: Quality improvement process must address all 8 factors of MEM 4A and 4B This is one of the most significant changes Scope of QI process was previously unspecified Now 16 different measures are required
MEM 5: Health Plan Services
MEM 5A: Use of email to request an ID Card or PCP change does not meet requirement to complete these actions in one attempt or session via the web
MEM 6: Innovations in Service
MEM 6A: Two new ways to provide online personal health records: Allowing members to track personal health
information on a “sheet” accessible through the health plan’s web site
Providing a link from the health plan’s web site to a free online personal health record and encouraging members to access it
MEM 7: Health Information Line
MEM 7A: Access to health information line by email has been clarified It is acceptable to use a non-email web-based
messaging system rather than traditional email
Just a note…
Although these are the most significant changes there are others
Remember to check NCQA’s website for periodic updates
If you need accreditation-related help, contact The Mihalik Group