ncqa accreditation ncqa standards Oct 19, 2022

Steps to take NOW with the 2023 NCQA standards

The 2023 NCQA Standards and Guidelines have been released, and now it’s time for you to act! While you may be in the midst of preparing for your upcoming survey on the 2022 standards, you must also be alert to new changes that could impact your organization. Here are the steps we recommend you take.   

  •  Purchase the 2023 standards with the appropriate licenses for the number of users in your organization. Not sure about how many licenses to purchase? Check out NCQA’s guidelines in the Store at Plan a comprehensive review of the new standards, with particular attention to brand-new requirements for 2023 and their look-back periods compared to your next survey.  Let MHR know if you need assistance, as we have a Training session on Annual Standard Changes where the presenter identifies specific implications of the major changes and relevant Policy Clarification Support (PCS) questions and FAQs since the standards’ last publication.
  • Be aware that the Summary of Changes in each of the Elements does not contain all modifications, only a high level. Your SMEs must review the language in the Explanations and compare it to the 2022 standards to ensure all changes are noted.
  • Decide what modifications your organization or delegates must make to documented processes, reports, materials, or files. Check if any requirements involve IT system changes or other data needs and reach out to the appropriate IT support and analysts.
  • Create an action plan with a list of required modifications, due dates, and accountable persons from your organization and delegates. Keep in mind the look-back period for all requirements! 
  • After the standards are published, NCQA releases a document called NCQA Corrections, Clarifications, and Policy Changes to the 2023 Standards and Guidelines, usually around November. Check the policy clarifications, policy corrections, and policy changes to the 2023 standards. NCQA requires all corrections and changes to be made within 90 days of the Interactive Review Tool (IRT) release date. 
  • Follow through on your action plan. Check dates on documented processes, reports, and materials and any new items from the list of clarifications, corrections, and changes. Validate that any changes to IT systems are processed according to specifications.

As you work through your action plan, MHR is doing the same!  As President and CEO, I review all programs for changes in standards for the new current year. Then, our team meets and discusses how the changes will impact our clients and what internal modifications we must make for our consulting services and products.

Our plan includes updates to our tools, templates, and training, or if a new training session must be developed.  For example, when new standards on System Controls were implemented, and the new Health Equity Accreditation program was launched, MHR was ready with new training for our clients. 

We know timeliness is critical to the success of your accreditation or certification.  So, when new requirements are published, you are our priority.  We reach out to our clients to be sure they are aware of what actions they must take, with attention to look-back periods, policy corrections, and changes.  Through our consultation services, we will assess your readiness for all requirements, determine your risk, and help you track your progress using our Gap/Readiness Assessment/Project Management Tool.

Here is an example of a few changes for 2023, but keep in mind that you will need to review the complete 2023 NCQA Standards and Guidelines for all updates. 

QI 1B: NCQA added a documented process for First and Renewal Surveys.

QI 3A: NCQA added a clarification for Continuity and Coordination that all product lines (Commercial, Exchange, Medicare, and Medicaid) must be represented across measures and opportunities.

QI 4A: Added severe emotional disturbance to measurement along with severe mental illness and removed the exception for organizations that do not have adult membership.

Many Elements: specified the requirement for providing three reports for the survey…among other changes!

Your Call to Action:

  • Purchase the new standards
  • Review the Summary of Changes and Explanations for all changes
  • Communicate new requirements and look-back periods
  • Create an action plan and follow through on due dates
  • Check with MHR for additional Training

Be alert to how requirements can change as new standards are released each year, and policy clarifications, corrections, or changes follow, usually around March and November.  Follow a systematic process in implementing modifications.  Check with your MHR consultant for help with training or other NCQA accreditation or certification needs.     

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