All materials © 2012, National Committee for Quality Assurance NCQA Update National Credentialing Forum February 6, 2014

2 NCQA Update February 6, 2014 EXCHANGES

3 NCQA Update February 6, 2014 Federally-Facilitated Exchanges: Requirements Phase in Certification Year QHP issuers without existing accreditation QHP Issuers with existing Commercial, Medicaid accreditation for the state Year 1 (2013) Schedule accreditation review Attest that accredited policies and procedures are comparable to Exchange (not all the same) Years 2 and 3 ( ) Be accredited for Exchange product (policies and procedures) Attest that accredited policies and procedures comparable to Exchange Year 4 (2016) Exchange product is accredited, performance data submitted

4 NCQA Update February 6, 2014 HPA EVALUATION OPTIONS

5 NCQA Update February 6, 2014 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 NCQA Update February 6, 2014 Three Evaluation Options Evaluation Option EligibilityDuration Scope Interim Unaccredited plans 18 months Policy/Procedures (prior to survey look back period) No file review First Unaccredited plans36 months Policy/Procedures and evidence of implementation (6 month look back) Renewal Plans with NCQA Accreditation 36 months Policy/Procedures and evidence of implementation (24 month look back)

7 NCQA Update February 6, 2014 How Measures and Scoring Fit In Evaluation Option Measure Requirements Maximum Point Allocation Maximum Status Interim Not RequiredStandards—50 points Interim First Optional Standards—50 points Accredited Standards—50 points HEDIS—37 points CAHPS—13 points Excellent Renewal Required Standards—50 points HEDIS—37 points CAHPS—13 points Excellent

8 NCQA Update February 6, 2014 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 NCQA Update February 6, 2014 CREDENTIALING UPDATE 2014

10 NCQA Update February 6, 2014 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 NCQA Update February 6, 2014 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 List-of-Essential-Community-Provide/ibqy-mswq for a full list. List-of-Essential-Community-Provide/ibqy-mswq

12 NCQA Update February 6, 2014 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.