MHR Newsletter

2024 #2
February 19, 2024
By: Nancy Ross Bell

From Susan 

Reading articles such as Bold Predictions for Healthcare in 2024 makes me think about our clients responding to these changes and how MHR will be ready to help pursue NCQA Accreditation. Providers are not alone. Health Plans, MBHOs, Care Management Organizations, and CVOs are in the midst of reacting to mergers & acquisitions, new regulations, medical policies on new technology, demands for higher quality, staff shortages, and the like. NCQA is very involved in the hospital-at-home trend, and CR and UM standalone products fit well in this space, as do CM and PHP. Rest assured, MHR remains ready to work with all types of organizations and all NCQA Accreditation or Certification programs. MHR probably has the most varied clientele of any organization of its size, and the consultants are used to adapting standards to fit the type of client they are working with.

As I work with MHR’s team of consultants, I am in awe of their expertise, knowledge, and experience both in their work lives before coming to MHR and their consulting experience since and how that translates to guiding our clients in achieving their NCQA goals! We work hard at being the best through ongoing team collaborations and training. I often hear from new clients how we stand out among other consultants and firms.  One recently mentioned that our consultants do not just have a theoretical knowledge of the standards to regurgitate the information in the standards but can provide different ways to apply the standards to meet requirements. That is what we strive for.

Another way we stand out is that we believe, speak, and practice our vision:

“We empower healthcare organizations to reach their fullest potential through successful NCQA accreditation, driving excellence and raising the bar in healthcare quality standards.”

At the start of each monthly team meeting, I review our vision and discuss how it impacts our work. Our recent discussion centered on how we help bring value to your organization.

A third way we stand out is by taking your unique circumstances and collaborating with NCQA’s Policy department to clarify situations that may not “fit” within a standard.  Then, we discuss that resolution among our team so cross-training occurs.  You can read about some recent clarifications we sought for clients in this month’s Quality Insights.  

Save the date! Mark your calendars for April 12, 2024 (noon EST) for the first client-only training for 2024. We will bring you the latest news from NCQA that can impact your next survey and give you time to submit your questions to our consultants. 

Learn more about MHR’s CONSULTANT, Kim Carpenter Petit. See what keeps her busy outside of NCQA!

And don’t stop when you finish reading about Kim. You’ll want to keep abreast of the coming CMS prior authorization requirements, savings in the No Surprises Act, and much more in our curated content. Below that are highlights from questions recently posed to NCQA’s Policy area that fit into the “Don’t Miss” category under Quality Insights.

As always, let your MHR Consultant or me know how we can help.

Susan K. Moore, President & CEO



MHR Consultant

Sheila Petras, MHR Consultant

MHR Consultant, NCQA Surveyor and Trainer, competitive club tennis player, mom to a 10-year-old son, and partner with her husband on an organic farm in western Illinois are some of the hats that Kim Carpenter Petit currently wears! However, her prior role at a national health plan, where she gained an intense knowledge of the NCQA standards, drew Susan Moore to recruit her to MHR consulting if and when she was ready for a change!

That change came in 2017 when Kim joined MHR. She now consults on nearly all Health Plan standards, helps conduct client-only webinar training sessions, completes staffing assessments, and has developed numerous templates and materials in use by MHR consultants and their clients. One of Kim’s passions is population health management, stemming from her involvement with NCQA in helping develop the original NCQA Surveyor Training on PHM standards.

Kim strongly advocates MHR’s premise that when you “teach people to fish,” instead of fishing for them, they become more independent in sustaining and preparing for their next NCQA survey. Kim is most gratified when her clients attain that level of independence, she knows that she was instrumental through her training and coaching of subject matter experts to understand the intent and detail behind the standards.

A strong attribute of Kim is that she loves untangling and tackling complex and hard issues!  Mergers and acquisitions, multiple legal entities, states, and products, along with a long list of vendors and delegates and the ability for auto-credit, are examples of what propels her into problem-solving mode!  There is very little that Kim has not come across in the realm of preparing health plans for their NCQA survey.

MHR clients working with Kim can be assured they are working with someone with keen insight into NCQA and who will work diligently for their success!

Read more about Kim


We asked!

At times, our clients may have situations that aren’t spelled out precisely in the standards. When this occurs, MHR asks the NCQA Policy department for clarification on your behalf. If we feel that others may have similar questions, we would like to pass them along to you, such as the ones below.  If you have a similar question, be sure to ask your MHR Consultant so we may get clarification from NCQA.

  • 16 organizations that are NCQA Accredited for Credentialing are currently under a Corrective Action Plan (CAP). Some may need to correct a policy for CR 1C Systems Controls. If that is the only issue under your CAP, you may go ahead and apply for your CAP Survey and request a date. NCQA will not require that the revised policy be in place for at least six months but will confirm that the necessary corrections were made during their review.
  • Are you preparing for your Initial Survey for NCQA Health Equity Accreditation? If you plan to submit an Implementation Plan for a report or material for HE 2 D&E, you must also submit a documented process for collecting data from individuals. The Implementation Plan must be detailed and specific about how the data will be collected and include a timeline. Caution: Factor 1 for both HE 2 D&E is a Critical factor.  Also, refer to the scope of review.
  • Can an organization use alternative language for collecting health equity data for HE 2? While wording including “same-sex oriented” in place of “lesbian or gay or homosexual” was acceptable, using “other” alone without the ability to “describe” was not. Caution:  If you use an alternative language that NCQA has approved, you must map the data to NCQA’s categories outlined in the standards.
  • What type of practitioner under UM 4E is qualified to review pharmaceutical devices covered under an organization’s medical or pharmacy benefit? A physician is an appropriate practitioner for all types of UM denials, including requests for durable medical equipment such as glucose monitors. A denial for a glucose monitor based on medical necessity would be included in the file review universe for non-behavioral health denials.  Read more about this in our blog, Deciphering NCQA UM File Reviews.

Keep updated with MHR’s Blogs and Newsletters!

MHR’s Blogs and Newsletters are written with YOU in mind – the people doing the work for an upcoming NCQA survey and keeping quality in check once your survey scores are in!  Be sure to distribute them to your quality teams as they provide unique insights from our Consultants.

News from NCQA:

Inside Health Care #124:  Targeting Health Equity Gaps with Digital Tools

Three Focus Areas for Improving Behavioral Health

NCQA’s Health Plan Ratings 2024


February 22, 2024
NCQA’s Live Webinar on Race, Ethnicity, SOGI, Income, and Language in Patient Reg

  • Webinar

February 22, 2024
Exploring the Diversity and Growth of the Asian American Population

  • Webinar

February 27-29, 2024
AHIP Executive Leadership Summit

  • Phoenix, AZ

March 4-5, 2024
NCQA Health Equity Forum

  • Los Angeles, CA

March 12-14, 2024
2024 Medicare, Medicaid, Duals, & Commercial Market Forum

  • Baltimore, MD

April 2-3, 2024
RISE The Medicaid Managed Care Leadership Summit

  • Virtual

April 12, 2024
MHR’s Client-Only Training – Save the Date

  • Live Webinar

April 19-22, 2024
2024 National Conference American Case Management Association

  • Nashville, TN

May 1-3, 2024
RISE The Special Needs Plan Leadership Summit

  • New York

May 29-30, 2024
CMS Health Equity Conference

  • Bethesda, MD/Virtual

June 2-4, 2024
RISE Qualipalooza 2024

  • Atlanta

June 11-13, 2024
AHIP 2024

  • Las Vegas, NV

August 9, 2024
MHR’s Client-Only Training – Save the Date

  • Live Webinar

September 9-11, 2024 – Save the Date
NAHQ Next 2024

  • Virtual

October 31-November 2, 2024 - Save the Date
NCQA Health Innovation Summit

  • Nashville, TN

December 13, 2024
MHR’s Client-Only Training – Save the Date

  • Live Webinar


MHR was incorporated in 1991 and specializes in preparing organizations for all NCQA accreditation and certification products.

All MHR consultants were responsible for NCQA accreditation in their previous roles before joining MHR as an independent consultant. Most consultants are also NCQA surveyors and the majority are clinicians. 

We welcome hearing from you! 

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