Accreditation 99 At-A-Glance
o What it is.
New standards from the National Committee for Quality Assurance that will tie performance on clinical, satisfaction, service, and access measures to accreditation. Accreditation 99 also added a new designation of "excellent" and changed the format of reporting plan performance to address consumer needs.
o New consumer protections.
- Prohibit plans from using financial incentives to encourage managers to limit or deny care.
- Require plans to have a process for approving exceptions to restricted drug formularies.
- Include an evaluation of whether plans unduly limit access to emergency department care.
- Require plans to coordinate medical and behavioral health care.
o Performance measures.
- Will count for 25% of the accreditation score.
- Will be compared against national and regional averages and national benchmarks (or best performers).
- Must be audited according to the standards of NCQA's HEDIS Compliance Audit program.
List of performance measures
o Clinical measures.
- Childhood immunization status.
- Adolescent immunization status.
- Breast cancer screening.
- Cervical cancer screening.
- Prenatal care in the first trimester.
- Advising smokers to quit.
- Beta-blocker treatment after a heart attack.
- Eye exams for people with diabetes.
- Checkups after delivery.
- Follow-up after hospitalization for mental illness.
- Flu shots for the elderly.
o Non-clinical measures.
- Getting care quickly.
- Doctors who communicate.
- Courteous and helpful office staff.
- Easy to find a personal doctor or nurse.
- Getting needed care.
- Claims processing.
- Customer service.
- Rating of personal doctor or nurse.
- Rating of specialist seen most often.
- Rating of health care in the past 12 months.
- Rating of experience with health plan.
o Comment period.
NCQA is accepting comments on the standards through May 15.
To receive a copy of the standards, contact the NCQA customer service center, 2000 L St., NW, Suite 500, Washington, DC 20036. Telephone: (202) 955-5697. Or you may download them from NCQA's World Wide Web site: http://www.ncqa.org/99draft.htm.
NCQA will accept written comments only via regular mail or through e-mail: mcodraft@ncqa.org.
