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.