HOW WE WORK

How Do You Update Your E-Pub Standards with NCQA Policy Changes & Corrections?

Not implementing corrections and changes to the NCQA standards on time can negatively impact survey scores. On-time means corrections and policy changes must be implemented within 90 calendar days of the Interactive Review Tool (IRT) release date.

If your organization does not have an internal operating procedure for these updates, read how MHR works behind the scenes to download, update, disseminate, and implement this critical information.

Why Does This Matter?

In the last days of March, July, and November NCQA releases NCQA Corrections, Clarifications, and Policy Changes found at Policy Updates for Accreditation and Measurement. Once these updates are added to the IRT, the 90 calendar days begin for corrections (changes made to rectify an error made in the Standards & Guidelines) and policy changes (modifications of an existing requirement) to be implemented.  

Behind the Scenes: How MHR Stays Current on NCQA Updates

If your organization lacks a process for updating your E-Pub standards with NCQA’s updates, follow along and use ours as a guide.

1. NCQA’s E-Pub standards are securely saved in MHR’s Box® folder with access controlled by MHR’s President & CEO. Access is limited to the number of licenses that MHR has purchased for those standards.
2. MHR’s Virtual Assistant (VA) monitors NCQA’s website and, once the updates are released, promptly downloads and saves each document.
3. The first three columns within the documents, Page, Standard/Element, and Head/Subhead, are located in the Standards & Guidelines for the specific NCQA program.
4. The content within the fourth column of the document, the Update, is copied and pasted to MHR’s E-Pub version. New text is added in red font, and strikethrough shows text to be deleted.
5. The 90-calendar-day due date is added and highlighted next to the update.
6. Once completed, the MHR Team is advised.

Behind the Scenes: MHR’s Next Steps

Our next steps help ensure our clients implement changes on time.

1. Changes and impacts are discussed at the next MHR Team Meeting
2. MHR Consultants discuss updates with clients as appropriate
3. MHR’s Templates, Tools, and Training are updated
4. Changes are added to the next Triennial client-only web
5. Reminders are added to blogs and newsletters

 What Are Your Next Steps?

• Do you have an internal process for updating your E-Pub standards?
• Are release dates in late March, July, and November on your tracking calendar?
• Has accountability been assigned?
• How and to whom are changes communicated?
• For changes impacting Data Sources or may require IT system changes, is an action plan in place to effect the change within 90 calendar days of the IRT release date?

MHR PRODUCTS

Delegation Suite

NCQA Delegation has it all, from Elements on Delegation Agreements, Predelegation Evaluation, and Review of Delegated Activities to Opportunities to Improve, and crosses over eight standard sets (CR, LTSS, ME, MED, NET, PHM, QI, and UM) for NCQA Health Plan Accreditation!

Delegation spurs many questions, such as, Is this relationship a vendor or a delegate? How many delegate files are included in the upcoming File Review by NCQA? Is the potential delegate NCQA Accredited? Are we eligible for automatic credit?

Because of its complexity, MHR has developed a comprehensive set of tools and templates for NCQA’s Delegation requirements, referred to as our Delegation Suite, which is designed to guide organizations through the standards and ease angst about how to comply!

Considering requirements on roles, responsibilities, and reporting within a Delegation Agreement, we especially call attention to the usefulness of these tools for interdisciplinary teams that may include quality/accreditation, legal, and contracting specialists, among others.  

What’s Included in the Delegation Suite?

The Delegation Suite spans all standards and includes:

• Delegation Program Guide to establish an NCQA-compliant delegation oversight program
• Delegation Agreement Checklists and Tables for each standard set
• Audit Tools to track delegates and reports
• Sample Audit Request Letter Template
• Tracking Log for Vendors & Delegates
• Oversight Summary Reports

When purchasing the Delegation Suite, all updates through standards year 2028 are included in the initial purchase price. Please note that these documents are purchased by your organization, and therefore, you have purchased a license to use them.

There is the capability and directions to share oversight results with your delegates, but the license does not allow you to share the evaluation tool documents with them before changing the documents to PDFs without the embedded formulas. An explanation of how to do this is in the documentation.

The MHR copyright must always be present on the documents provided. All organizations want to give delegates the tools to be successful, as it’s to your benefit to assist them in meeting standards. If the delegates are interested in the tools, we will be allowing non-clients to purchase them in the next month. We want them to be successful in supporting our clients. Delegation is high risk and is an area in which most organizations have gaps.

A Hallmark of MHR Tools & Templates

MHR has built its proprietary tools & templates with features to help you work more efficiently and accurately. The flow of reporting is clear and concise, which is preferred by most NCQA surveyors.

Features added to MHR tools & templates are:   

• Red text that shows organizations where to fill in the blanks
• Green text that provides examples of model language
• Shaded text boxes with instructions on what you must explain
• Tables where data should be entered

Next Steps

• Ask your MHR Consultant for more details and prices.

If you are not an MHR client but are interested in the Delegation Suite, let us know.  Contact MHR.