1. Changes to NCQA Health Plan Accreditation for 2009 Gary J. Mihalik, MD, MBA The Mihalik Group, LLC 1300 W. Belmont #500 Chicago, IL 60657 www.themihalikgroup.com

2. Objective To highlight the most significant changes to NCQA’s Health Plan Accreditation Standards for 2009

3. General Observations: HPA 2009 No new standards added No standards removed Most changes are “clarifications” although some are significant Standards now constitute 57 out of the 100 points used to determine accreditation status  Down from 61.3 points in 2008

4. QI 9: Clinical Practice Guidelines QI 9A: CPGs must be in place 24 months or longer at time of survey This will require that the process for review and update, specified in Factor 3, be implemented

5. MEM 1: Health Risk Appraisals MEM 1F: HRA must be available by a means other than on-line Printed HRAs must contain the same content as the web-based version, including follow- up resources

6. MEM 4: Pharmacy Benefit Info MEM 4A and 4B: Use of a PBM is considered delegation  All requirements of MEM 9 (Delegation) apply MEM 4C: Quality improvement process must address all 8 factors of MEM 4A and 4B  This is one of the most significant changes  Scope of QI process was previously unspecified  Now 16 different measures are required

7. MEM 5: Health Plan Services MEM 5A: Use of email to request an ID Card or PCP change does not meet requirement to complete these actions in one attempt or session via the web

8. MEM 6: Innovations in Service MEM 6A: Two new ways to provide online personal health records:  Allowing members to track personal health information on a “sheet” accessible through the health plan’s web site  Providing a link from the health plan’s web site to a free online personal health record and encouraging members to access it

9. MEM 7: Health Information Line MEM 7A: Access to health information line by email has been clarified  It is acceptable to use a non-email web-based messaging system rather than traditional email

10. Just a note… Although these are the most significant changes there are others Remember to check NCQA’s website for periodic updates periodic updates If you need accreditation-related help, contact The Mihalik GroupThe Mihalik Group