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2014 NCQA Credentialing Forum: Updates on Federally-Facilitated Exchanges Requirements

This summary provides insights from the 2014 NCQA National Credentialing Forum held on February 6, focusing on evaluation options for federally-facilitated exchanges. It outlines the distinct combinations of requirements, scoring, statuses, and accreditation lengths. Key updates include the introduction of new credentialing verification factors and the possibility of adding essential community providers and children's dental services to exchange accreditation requirements by 2016. This evolution aims to enhance healthcare provider accessibility and quality for underserved populations.

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2014 NCQA Credentialing Forum: Updates on Federally-Facilitated Exchanges Requirements

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  1. NCQA Update - 2014 National Credentialing Forum February 6, 2014

  2. Exchanges

  3. Federally-Facilitated Exchanges: Requirements Phase in

  4. HPA 2013 - 2014Evaluation Options

  5. What is an Evaluation Option? • An Evaluation Option is defined by its distinct combination of: • Requirements (standards and measures) • Scoring • Statuses • Length of accreditation

  6. Three Evaluation Options

  7. How Measures and Scoring Fit In

  8. So what’s happened • NCQA has accredited XXX Exchanges • Were accredited under the Interim standards or as an “Add-on” to currently accredited plans • Those with Interim status will be coming through First Evaluation Option at the end of December 2014 and 2015.

  9. Credentialing update 2014

  10. CR 3: Credentialing Verification • Added • Factor 4: Verification of board certification status, if applicable. • Documentation • No new requirements • Rationale • Allows separate verification of boards that cannot be used to meet E & T requirement. • Allows for verification of certification for recertification.

  11. Possible Change in 2016 • Adding the following for Exchanges • Essential Community Providers (ECP) • Providers with experience caring for medically underserved populations. • Include community health clinics, Ryan White HIV/AIDS providers, Family Planning Providers (Title X Family Planning Clinics), Indian Providers and safety-net hospitals (hospitals that receive disproportionate Share Hospital funding), STD Clinics, TB Clinics, Hemophilia Treatment Centers, Black Lung Clinics. • Go to https://data.cms.gov/dataset/Non-Exhaustive-List-of-Essential-Community-Provide/ibqy-mswq for a full list.

  12. Possible Change in 2016 • Adding the following for Exchanges • Children’s Dental Services • Currently only oral surgeons are included in NCQA credentialing requirements. • May need to add dentists who treat children in future.

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