{"id":12626,"date":"2019-07-29T10:11:18","date_gmt":"2019-07-29T14:11:18","guid":{"rendered":"https:\/\/www.ncqa.org\/?page_id=12626"},"modified":"2025-12-05T16:47:15","modified_gmt":"2025-12-05T21:47:15","slug":"hpa2020","status":"publish","type":"page","link":"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/","title":{"rendered":"Health Plan Accreditation: 2020 Update"},"content":{"rendered":"<h2>CANCELLATION NOTICE<\/h2>\n<p>Due to COVID-19, NCQA will not release 2020 Health Plan Ratings for any product line.<\/p>\n<p>Accredited commercial and Medicaid plans must still submit the required HEDIS and CAHPS measures in order to meet annual reporting requirements; however, organizations <strong>will not<\/strong> be rated on measure results. A list of required measures for reporting is located <a href=\"https:\/\/wpcdn.ncqa.org\/www-prod\/2020\/02\/20200206_List_of_Required_Performance_Measures.pdf\">here<\/a>.<\/p>\n<p>See our <a href=\"https:\/\/wpcdn.ncqa.org\/www-prod\/2019\/07\/20190723_HPR_Advertising_and_Marketing_Guidelines.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Health Plan Ratings Marketing and Advertising Guidelines<\/a> for more information regarding the continued usage of 2019 Health Plan Ratings for advertising and marketing purposes.<\/p>\n<p>See our\u00a0<a href=\"https:\/\/www.ncqa.org\/covid\">COVID-19 resource page<\/a>\u00a0for more information.<\/p>\n<p>Every year, NCQA adjusts its standards and guidelines in response to feedback from plans, policy makers, providers, patients and others. In 2019 we also updated our scoring methods and how we award Accreditation. The result is a more straightforward and transparent process that maintains strong consumer protections.<\/p>\n<p>We focused on the following areas for Health Plan Accreditation 2020:<\/p>\n<ol>\n<li><strong>Align Health Plan Accreditation and Health Plan Ratings.<\/strong> We improved the methodology used to evaluate and communicate health plan performance on clinical (HEDIS<sup>\u00ae<\/sup>) and patient experience (CAHPS<sup>\u00ae<\/sup>) measures, making it easier to understand how well a plan performs.<\/li>\n<li><strong>Simplify scoring and improve transparency.<\/strong> We transitioned scoring from a complex points system to simpler scoring thresholds.<\/li>\n<li><strong>Strengthen consumer protections.<\/strong> We strengthened oversight in Utilization Management (UM) and Credentialing (CR) standards by adding new requirements and elements as \u201cmust-pass.\u201d<\/li>\n<li><strong>Reduce the paperwork burden on health plans.<\/strong> We retired 22 elements and reduced the number of elements for which plans must show evidence during renewal. We\u2019ve done this while maintaining a focus on policy implementation and core consumer protections.<\/li>\n<li><strong>Survey tool and process improvements.<\/strong> NCQA is enhancing the survey tool and simplifying the Accreditation process to improve the customer experience.<\/li>\n<\/ol>\n<p>You can <a href=\"http:\/\/store.ncqa.org\/index.php\/accreditation\/health-plans-hp.html\">purchase the standards here<\/a>.<\/p>\n<h2>More Information<\/h2>\n<h3>Updates to Scoring, Accreditation Statuses and Report Cards<\/h3>\n<p>Before the 2020 standards year, 50 percent of the points organizations earn toward Accreditation was based on standards (processes, policies and procedures) and 50 percent was based on measures (HEDIS<sup>\u00ae<\/sup>\/CAHPS<sup>\u00ae<\/sup> reporting). NCQA also releases yearly Health Plan Ratings to highlight strong performance in quality and patient experience.<\/p>\n<p>Because the scoring methodology in Health Plan Ratings and in Accreditation statuses are different, scoring can be confusing. Employers, states and consumer advocates are looking for one source that is the authority on how plans perform.<\/p>\n<p>Therefore, beginning with Health Plan Accreditation 2020 and the 2020 HEDIS reporting year, Health Plan Ratings and Accreditation will align. This will improve consistency between Health Plan Ratings and Accreditation and create a simpler and more transparent scoring methodology for Accreditation. <a href=\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/scoring-updates\/\">Learn more.<\/a><\/p>\n<h3>Reduction in Total Requirements<\/h3>\n<p>As a way to reduce burden on health plans, NCQA routinely retires requirements that have become standard practice or are no longer in line with market needs. For 2020, NCQA retired 22 requirements and reduced the number of requirements for which plans need to submit evidence at renewal. <a href=\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/reduced-requirements\/\">Learn more.<\/a><\/p>\n<h3>New Requirements\/Consumer Protections<\/h3>\n<p>In response to feedback from states and other stakeholders, NCQA identified requirements that will be must-pass elements starting in 2020. These elements, in the Credentialing and Utilization Management categories, will strengthen consumer protections and help organizations manage their procedures and risk. We will also begin reviewing UM denials by product line. <a href=\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/new-requirements\/\">Learn more.<\/a><\/p>\n<h3>Reporting Timetable<\/h3>\n<p>To strengthen our quality measurement, NCQA modified the timetable for HEDIS<sup>\u00ae<\/sup> and CAHPS<sup>\u00ae<\/sup> reporting for organizations seeking initial Accreditation. Organizations that are already Accredited and reporting HEDIS\/CAHPS will see no change. <a href=\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/reporting-requirements\/\">Learn more.<\/a><\/p>\n<h3>Survey tool and process improvements.<\/h3>\n<p>NCQA is updating the survey tool and simplifying the Accreditation process to improve the customer experience. NCQA is enhancing the application, making file reviews more efficient, improving document management and creating a unified view for linked licenses and Single Site Multiple Entity (SSME) Surveys. <a href=\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/experience\/\">Learn more.<\/a><\/p>\n<h3>Learn More at Health Care Quality Congress<\/h3>\n<p>Each year, the Health Care Quality Congress offers an accelerated familiarization program on the annual new releases of improvements to NCQA Accreditation standards and guidelines. The meeting is your first opportunity after the release of the Health Plan Accreditation standards and HEDIS measures to ask questions, learn about the latest developments directly from experts and develop your organization\u2019s ability to offer high-quality, value-based care. <a href=\"https:\/\/www.healthcarequalitycongress.com\/\" target=\"_blank\" rel=\"noopener noreferrer\">Register today.<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>CANCELLATION NOTICE Due to COVID-19, NCQA will not release 2020 Health Plan Ratings for any product line. Accredited commercial and Medicaid plans must still submit the required HEDIS and CAHPS measures in order to meet annual reporting requirements; however, organizations will not be rated on measure results. A list of required measures for reporting is [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"parent":925,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page.php","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-12626","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Health Plan Accreditation: 2020 Update - NCQA<\/title>\n<meta name=\"description\" content=\"Due to COVID-19, NCQA will not release 2020 Health Plan Ratings for any product line.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Health Plan Accreditation: 2020 Update - NCQA\" \/>\n<meta property=\"og:description\" content=\"Due to COVID-19, NCQA will not release 2020 Health Plan Ratings for any product line.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/\" \/>\n<meta property=\"og:site_name\" content=\"NCQA\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/NCQA.org\" \/>\n<meta property=\"article:modified_time\" content=\"2025-12-05T21:47:15+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.ncqa.org\/wp-content\/uploads\/2021\/04\/NCQA_cmyk_tag.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"627\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:site\" content=\"@NCQA\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/\",\"url\":\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/\",\"name\":\"Health Plan Accreditation: 2020 Update - NCQA\",\"isPartOf\":{\"@id\":\"https:\/\/www.ncqa.org\/#website\"},\"datePublished\":\"2019-07-29T14:11:18+00:00\",\"dateModified\":\"2025-12-05T21:47:15+00:00\",\"description\":\"Due to COVID-19, NCQA will not release 2020 Health Plan Ratings for any product line.\",\"breadcrumb\":{\"@id\":\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.ncqa.org\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Our Programs\",\"item\":\"https:\/\/www.ncqa.org\/programs\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Health Plans\",\"item\":\"https:\/\/www.ncqa.org\/programs\/health-plans\/\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Health Plan Accreditation\",\"item\":\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/\"},{\"@type\":\"ListItem\",\"position\":5,\"name\":\"Current Customers\",\"item\":\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/\"},{\"@type\":\"ListItem\",\"position\":6,\"name\":\"Health Plan Accreditation: 2020 Update\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.ncqa.org\/#website\",\"url\":\"https:\/\/www.ncqa.org\/\",\"name\":\"NCQA\",\"description\":\"Measuring quality. 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