State Briefing: HPA 2020 and HEDIS Changes

Last week, NCQA’s State Affairs Department held a briefing for state officials on upcoming changes to Health Plan Accreditation (HPA) 2020 and the Healthcare Effectiveness Data and Information Set (HEDIS®).

NCQA is releasing various updates across product areas. To align all the information, State Affairs presented key messages that states should consider as they are reviewing the changes and the potential impact of the changes on the states’ accreditation requirements.  Currently, 42 states deem or require NCQA Health Plan Accreditation.

Key Takeaways for States

  • States may need contract language changes.
  • Accreditation status will be changed. We heard from states, CMS and employers that, often, they were not able to distinguish among Accreditation status designations and they wanted to have greater transparency into how well a plan performed against the standards. As a result NCQA is eliminating the Excellent and Commendable status levels and will instead use the Health Plan Ratings to distinguish quality.
  • Updating the naming convention and timeline of HEDIS publications. Now, HEDIS 2020=Measurement Yea 2020. If contract language exists in your state that includes some publication years or timelines for data to be submitted to you, updates might be needed to align with the new naming convention. Additionally, measures will be released sooner… five months in advance of the measurement year.
  • Consumer protections are stronger. HPA 2020 will include some new must-pass elements, specifically in Utilization Management and Credentialing, that can strengthen the plans’ consumer protections.
  • Scoring is by product line. Plans are now required to show evidence by product line and will be scored accordingly. Additionally, Corrective Action Plans will be targeted to the product line where the score indicates the corrective action plan is needed. This helps clarify to plans, states and others where areas of concern lie and helps plans better focus on areas that need improvement.

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).