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NCQA Update - 2014

NCQA Update - 2014. National Credentialing Forum February 6, 2014. Exchanges. Federally-Facilitated Exchanges: Requirements Phase in. HPA 2013 - 2014 Evaluation Options. What is an Evaluation Option?. An Evaluation Option is defined by its distinct combination of:

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NCQA Update - 2014

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  1. NCQA Update - 2014 National Credentialing Forum February 6, 2014

  2. Exchanges

  3. Federally-Facilitated Exchanges: Requirements Phase in

  4. HPA 2013 - 2014Evaluation Options

  5. What is an Evaluation Option? • An Evaluation Option is defined by its distinct combination of: • Requirements (standards and measures) • Scoring • Statuses • Length of accreditation

  6. Three Evaluation Options

  7. How Measures and Scoring Fit In

  8. 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.

  9. Credentialing update 2014

  10. 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.

  11. 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.

  12. 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.

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