{"id":12661,"date":"2019-07-29T10:45:17","date_gmt":"2019-07-29T14:45:17","guid":{"rendered":"https:\/\/www.ncqa.org\/?page_id=12661"},"modified":"2025-12-05T16:49:08","modified_gmt":"2025-12-05T21:49:08","slug":"reduced-requirements","status":"publish","type":"page","link":"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/reduced-requirements\/","title":{"rendered":"Health Plan Accreditation 2020: Reduction in Total Requirements"},"content":{"rendered":"<p>NCQA regularly considers retiring requirements that have become standard practice or are no longer in line with market needs. For 2020, NCQA retired 22 elements and 7 factors. Some retired elements were duplicative; some were no longer necessary because they had become best practices.<\/p>\n<p>We also reduced the number of elements that require the plan to submit evidence at renewal. Combined with the retired elements, most plans will experience approximately a 34 percent reduction in elements that require evidence at renewal by focusing on elements showing implementation of policies and quality improvement.<\/p>\n<p>This helps reduce the burden of preparation while maintaining strong consumer protections.<\/p>\n<h3>Information for Medicaid Plans<\/h3>\n<p>Medicaid plans will still have a reduction in total requirements, but will be required to show evidence so Accreditation can still meet some CMS oversight requirements.<\/p>\n<ul>\n<li>CMS has certain requirements for Medicaid plans that must be reviewed on a regular basis by states.<\/li>\n<li>Some states deem NCQA Accreditation, which means they use NCQA Accreditation as part of their oversight and compliance.<\/li>\n<li>As a result, for Medicaid plans, there are several requirements retired as part of the standards update for health plans Accreditation, or that are not reviewed as part of renewal, that will still be reviewed for Medicaid plans, as they are CMS requirements that need to be reviewed in order for deeming to occur. This helps assure that NCQA still supports Medicaid plans and helps them meet CMS Managed Care requirements.<\/li>\n<li>These include:\n<ul>\n<li>The following elements were retired, but moved to the Medicaid Module for plans that seek to earn that status:\n<ul>\n<li>QI 2B: Informing Members<\/li>\n<li>UM 4G: : Affirmative Statement About Incentives.<\/li>\n<\/ul>\n<\/li>\n<li>The following elements will still be reviewed at renewal for Medicaid plans only.\n<ul>\n<li>QI 1A: QI Program Structure (formerly QI 1, element A, factors 1-5, 7)<\/li>\n<li>QI 2A: Practitioner Contracts (formerly QI 3A)<\/li>\n<li>NET 5A: Physician Directory Data (formerly NET 6A)<\/li>\n<li>NET 5B: Physician Directory Updates (formerly NET 6B)<\/li>\n<li>NET 5F: Hospital Directory Data (formerly NET 6G)<\/li>\n<li>NET 5G: Hospital Directory Updates (formerly NET 6H)<\/li>\n<li>UM 1A: Written Program Description<\/li>\n<li>UM 4A: Licensed Health Professionals<\/li>\n<li>UM 4B: Use of Practitioners for UM Decisions<\/li>\n<li>UM 8A: Internal Appeals<\/li>\n<li>CR 1A: Practitioner Credentialing Guidelines<\/li>\n<li>CR 1B: Practitioner Rights<\/li>\n<li>ME 1A: Rights and Responsibilities Statement (formerly RR 1A)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h2>NCQA will be retiring the following requirements in Health Plan 2020:<\/h2>\n\n<div class=\"table table-swipe\">\n    <div class=\"wrap\">\n        <table>\n                <thead>\n        <tr>\n            <th>Standard\/Element<\/th><th>What\u2019s Retiring?<\/th>        <\/tr>\n        <\/thead>\n                <tbody>\n                <tr>\n                        <td data-heading=\"Standard\/Element\">QI 2, Element B: Informing Members  <\/td>\n                        <td data-heading=\"What\u2019s Retiring?\">Element B<\/td>\n                    <\/tr>\n                <tr>\n                        <td data-heading=\"Standard\/Element\">QI 4, Element A: Member Services Telephone Access<br>\nQI 4, Element B: Behavioral Healthcare Telephone Access<br>\nQI 4, Element G: Assessing Experience With the UM Process\n<\/td>\n                        <td data-heading=\"What\u2019s Retiring?\">Elements A, B, G<\/td>\n                    <\/tr>\n                <tr>\n                        <td data-heading=\"Standard\/Element\">QI 5, Element D: Transition to Other Care, <i>factor 2<\/i><\/td>\n                        <td data-heading=\"What\u2019s Retiring?\">Factor 2<\/td>\n                    <\/tr>\n                <tr>\n                        <td data-heading=\"Standard\/Element\">PHM 4, Element A: Health Appraisal Components<br>\nPHM 4, Element B: Health Appraisal Disclosure<br>\nPHM 4, Element C: Health Appraisal Scope<br>\nPHM 4 Element D: Health Appraisal Results<br>\nPHM 4, Element E: Health Appraisal Format<br>\nPHM 4, Element G: Health Appraisal Review and Update Process<br>\nPHM 4, Element I: Usability Testing of Self-Management Tools<br>\nPHM 4, Element J: Review and Update Process for Self-Management Tools<br>\nPHM 4, Element K: Self-Management Tools Format\n<\/td>\n                        <td data-heading=\"What\u2019s Retiring?\">Elements A\u2013E, G, I, J<\/td>\n                    <\/tr>\n                <tr>\n                        <td data-heading=\"Standard\/Element\">PHM 5, Element F: Experience With Case Management<\/td>\n                        <td data-heading=\"What\u2019s Retiring?\">Element F<\/td>\n                    <\/tr>\n                <tr>\n                        <td data-heading=\"Standard\/Element\">MEM 2, Element A: Pharmacy Benefit Information\u2014Website, <i>factor 6, factor 7<\/i><br>\nMEM 2, Element B: Pharmacy Benefit Information\u2014Telephone, <i>factor 6, factor 7<\/i>\n<\/td>\n                        <td data-heading=\"What\u2019s Retiring?\">Factors 6 and 7<\/td>\n                    <\/tr>\n                <tr>\n                        <td data-heading=\"Standard\/Element\">MEM 3, Element A: Functionality\u2014Website<\/td>\n                        <td data-heading=\"What\u2019s Retiring?\">Factor 1<\/td>\n                    <\/tr>\n                <tr>\n                        <td data-heading=\"Standard\/Element\">MEM 4, Element A: Supportive Technology<\/td>\n                        <td data-heading=\"What\u2019s Retiring?\">Element A<\/td>\n                    <\/tr>\n                <tr>\n                        <td data-heading=\"Standard\/Element\">NET 4, Element A: Network Design Criteria for Practitioners<br>\nNET 4, Element B: Network Design Criteria for Hospitals\n<\/td>\n                        <td data-heading=\"What\u2019s Retiring?\">Elements A, B<\/td>\n                    <\/tr>\n                <tr>\n                        <td data-heading=\"Standard\/Element\">NET 6, Element E: Physician Information Transparency<br>\nNET 6, Element I: Hospital Information Transparency<br>NET 6, Element K: Usability Testing, <i>factor 1<\/i>\n<\/td>\n                        <td data-heading=\"What\u2019s Retiring?\">Elements E, I<br><br> Factor 1<\/td>\n                    <\/tr>\n                <tr>\n                        <td data-heading=\"Standard\/Element\">UM 5, Element A: Timeliness of Nonbehavioral Healthcare UM Decision Making<br>\nUM 5, Element C: Timeliness of Behavioral Healthcare UM Decision Making<br>UM 5, Element E: Timeliness of Pharmacy UM Decision Making\n<\/td>\n                        <td data-heading=\"What\u2019s Retiring?\">Elements A, C, E<\/td>\n                    <\/tr>\n                <\/tbody>\n        <\/table>\n    <\/div>\n<\/div>\n\n\n","protected":false},"excerpt":{"rendered":"<p>NCQA regularly considers retiring requirements that have become standard practice or are no longer in line with market needs. For 2020, NCQA retired 22 elements and 7 factors. Some retired elements were duplicative; some were no longer necessary because they had become best practices. We also reduced the number of elements that require the plan [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"parent":12626,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page.php","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-12661","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: Reduction in Total Requirements - NCQA<\/title>\n<meta name=\"description\" content=\"NCQA regularly considers retiring requirements that have become standard practice or are no longer in line with market needs.\" \/>\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\/reduced-requirements\/\" \/>\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: Reduction in Total Requirements - NCQA\" \/>\n<meta property=\"og:description\" content=\"NCQA regularly considers retiring requirements that have become standard practice or are no longer in line with market needs.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/reduced-requirements\/\" \/>\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=\"2025-12-05T21:49:08+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=\"2 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\/reduced-requirements\/\",\"url\":\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/reduced-requirements\/\",\"name\":\"Health Plan Accreditation 2020: Reduction in Total Requirements - NCQA\",\"isPartOf\":{\"@id\":\"https:\/\/www.ncqa.org\/#website\"},\"datePublished\":\"2019-07-29T14:45:17+00:00\",\"dateModified\":\"2025-12-05T21:49:08+00:00\",\"description\":\"NCQA regularly considers retiring requirements that have become standard practice or are no longer in line with market needs.\",\"breadcrumb\":{\"@id\":\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/reduced-requirements\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/reduced-requirements\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/reduced-requirements\/#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\",\"item\":\"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/\"},{\"@type\":\"ListItem\",\"position\":7,\"name\":\"Health Plan Accreditation 2020: Reduction in Total Requirements\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.ncqa.org\/#website\",\"url\":\"https:\/\/www.ncqa.org\/\",\"name\":\"NCQA\",\"description\":\"Measuring quality. 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