{"id":12679,"date":"2019-07-29T12:49:03","date_gmt":"2019-07-29T16:49:03","guid":{"rendered":"https:\/\/www.ncqa.org\/?page_id=12679"},"modified":"2025-12-05T16:48:11","modified_gmt":"2025-12-05T21:48:11","slug":"health-plan-accreditation-2020-current-customer-faq","status":"publish","type":"page","link":"https:\/\/www.ncqa.org\/programs\/health-plans\/health-plan-accreditation-hpa\/current-customers\/hpa2020\/health-plan-accreditation-2020-current-customer-faq\/","title":{"rendered":"Health Plan Accreditation 2020: Current Customer FAQ"},"content":{"rendered":"

Are you a health plan that is currently accredited by NCQA\/ Here are some common questions about Health Plan Accreditation 2020?<\/p>\n

Does my process for renewal change? <\/strong><\/p>\n

No. The overall process for renewing your recognition remains the same. However, for plans that have already earned accreditation, NCQA focused renewal on the implementation of processes and policies. As a result, we reduced the total number of elements you have to provide evidence for at renewal, reducing the amount of paperwork required.<\/p>\n

Instead of showing us evidence for all elements, we\u2019ve reduced that to 105 elements. Combined with the retired elements, that\u2019s a 34% reduction compared to what the majority of plans have to show today.<\/p>\n

Note: 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. Please reference the standards for a complete overview of requirements.<\/p>\n

In addition, NCQA us enhancing the survey tool and management of documents to make it easier on you.<\/p>\n

I currently have a status level of [Excellent, Commendable, Accredited]. What is changing about the status levels? <\/strong><\/p>\n

Today, NCQA has two different ways to look at a health plan\u2019s quality: the status a plan earns as part of accreditation (which can be excellent, commendable, accredited or provisional) and a numerical rating as part of annual Health Plan Ratings released each September. NCQA received feedback that these different methodologies can be confusing for consumers, employers and others trying to discern a health plan\u2019s quality.\u00a0 In addition, we received feedback that the different statuses weren\u2019t always a clear distinguisher of quality. Learn more here<\/a>.<\/p>\n

As a result, NCQA is using eliminating the \u201cExcellent\u201d and \u201cCommendable\u201d status levels and instead using health plan ratings as a means to distinguish health plan quality<\/strong>. Accredited plans will earn ratings once they submit HEDIS\u00ae and CAHPS\u00ae reporting and can advertise them with their accreditation. Ratings methodology is very similar to today, where performance measurement (HEDIS) and member experience (CAHPS) make up the ratings. Learn more here<\/a>.<\/p>\n

How long can I use my current status level?<\/strong><\/p>\n

NCQA will switch from status levels (e.g. Commendable, Excellent, Accredited) to star ratings in September 2020. You can use your current seal and level through September 2020, after which you can use an accredited seal with your star rating. For more information about this, view the latest policy update<\/a>.<\/p>\n

Based on my status level today, what star rating should I expect?<\/strong><\/p>\n

Below is a table detailing the projected stars your plan will receive based on your status today. There may be a few outliers, but you should generally expect the following:<\/p>\n\n

\n
\n \n \n \n \n \n \n \n \n
Current Status<\/font><\/th>Projected Stars<\/font><\/th> <\/tr>\n <\/thead>\n
Excellent<\/td>\n 4.5-5.0<\/td>\n <\/tr>\n
Commendable<\/td>\n 3.5-4.0<\/td>\n <\/tr>\n
Accredited<\/td>\n 2.5-3.0<\/td>\n <\/tr>\n
Provisional<\/td>\n 1.0-2.0<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n <\/div>\n<\/div>\n\n\n

Is Health Plan Ratings changing? \u00a0<\/strong><\/p>\n

The process and method for Health Plan Ratings are not changing beyond typical year-to-year methodology updates. However, there are two notable changes:<\/p>\n

    \n
  1. Star ratings:<\/strong> After receiving feedback from consumers and other stakeholders, NCQA is moving from a numerical rating to a star rating. The scale will still be 1-5.<\/li>\n
  2. Ratings web site:<\/strong> Right now there is a separate report card for accredited plans and a health plan ratings web site. These are being combined into one report card\/directory. This way consumers, employers, states and others can evaluate the quality of plans in one place. The new site will launch September 2020 when star ratings are released.<\/li>\n<\/ol>\n

    Learn more about the methodology for Health Plan Ratings<\/a>.<\/p>\n

    How do updates to Health Plan Accreditation 2020 impact my HEDIS reporting? \u00a0<\/strong><\/p>\n

    It will not. If you are already accredited and reporting HEDIS, you will continue to do so on an annual basis. For plans that will be earning a new accreditation (Interim or First surveys), HEDIS will be required to be reported at the first reporting cycle after the first full year of accreditation. Learn more about timing for newly accredited plans<\/a>.<\/p>\n

    What elements will be scored by product line? <\/strong><\/p>\n

    Starting in 2020, NCQA will report scores for standards by product line instead of averaged across product lines (read more about that here<\/a>). As part of this change, there are several elements where NCQA will begin collecting and scoring evidence by product line. As a result, plans will need to submit evidence by product line for the following elements:<\/p>\n