Last time I discussed the most significant changes to the Health Plan and MBHO UM standards. Today I’ll cover the highlights of the other categories.
Across all standards categories, there must be evidence that the delegation agreement was mutually agreed to before the delegate began performing delegated activities.
For organizations that delegate complex case management, there must be an annual file review of the delegate’s complex case management files. This is a new element scored by the surveyors. A similar element was added to UM. The focus of both is on whether the organization conducted an annual file review and reviewed the appropriate number of files.
Nurse practitioners are now included in the file pull for credentialing. In addition, NCQA clarified that the organization must credential all eligible practitioners regardless of whether they are in the file pull.
There are nine requirements for the QI work plan. All nine elements must be present for the work plan to be considered in compliance.
Practitioner availability must be measured separately for general practitioners/family practitioners; internists; and pediatricians.
If accessibility issues are identified in the organization-wide analysis, practitioner-level analysis is required to determine the cause.
For disease management organizations must identify psychosocial issues that may affect adherence, including: beliefs and concerns about the condition and treatment; perceived
barriers to meeting treatment requirements; access, transportation and financial barriers to obtaining treatment; and cultural, religious, and ethnic beliefs.
As always, if you need assistance with accreditation preparation, just contact us at marketing@themihalikgroup.com
