NCQA Modifies Scoring on Gender Identity, Diversity, Equity, and Inclusion Standards

By Nancy Ross Bell, RN

Estimated time to read: 3 minutes

As a federal contractor and in compliance with new Executive Orders, NCQA has modified scoring on standards related to gender identity, diversity, equity, and inclusion. The changes in scoring apply only to the Elements and Factors listed below and to surveys starting on or after February 12, 2025.

MHR Consultants are ready to help clients navigate through this change.

What You Need To Know

NCQA Programs Affected

Applicable standards fall within the following programs:

• Health Plan Accreditation (HPA)
• Health Equity Accreditation (HEA/HEA Plus)
• Managed Behavioral Healthcare Accreditation (MBHO)
• Accreditation in Case Management for LTSS programs (CM-LTSS)
• Accreditation and Certification in Wellness and Health Promotion (WHP)

Timeframe for Modifications

Scoring modifications apply to the timeframe specified below; however, NCQA may provide additional guidance.

• Scoring modifications apply to surveys starting on or after February 12, 2025, and will remain in effect until April 30, 2025,or until NCQA issues further guidance.  

Survey Scoring

Impacted Elements and Factors, as listed below, are scored in one of the following ways:

• Element is Not Applicable (NA)
• Element is scored without evidence of gender identity
• Element is scored without evidence of minimum requirement

NCQA Standards with Scoring Modifications

SCORE AS NOT APPLICABLE

HPA and MBHO: 

• QI 1E (MBHO) 
• PHM 3A, Factor 6
• PHM 1A, Factor 6

HEA/HEA Plus:

• HE 1A
• HE 1B
• HE 2A, Factor 3
• HE 2D
• HE 6B, Factor 3
• Plus 4A, Factor 3
• Plus 5D, Factor 3

CM-LTSS:

• LTSS 6A

WHP:

• WHP 1A, Factor 7

SCORE WITHOUT EVIDENCE OF GENDER IDENTITY

HEA:

• HEA-HE 2F
• HEA-HE 2G

SCORE WITHOUT EVIDENCE OF MINIMUM REQUIREMENT

HEA/HEA Plus:

• HEA-HE 5A, Factor 2
• HEA-Plus 4C, Factors 1-2
• HEA-Plus 4A, Factor 3

Impact To Points And Scores When Not Applicable

When Not Applicable (NA) is applied to a Factor listed under Score as Not Applicable, that Factor will be scored as Met (included in the numerator for Element scoring).   

When an entire Element is scored “NA”, points will be allocated as follows:

• For HPA and HEA, NCQA programs that use the Met scoring model, the Element’s points are removed from the denominator of points needed to achieve an Accredited status.
• For MBHO, NCQA programs that use percentage threshold scoring, the Element’s points are redistributed to the remaining Elements in the standard category.

Impact On Credentialing

Questions and answers related to scoring modifications are posted under NCQA’s FAQs.

Refer to the FAQ on practitioner credentialing applications for standards:

• HPA: CR 3, Element C, factor 6
• CRPN: CRA 3, Element A, factor 6; CRC 10, Element A, factor 6; CRC 11, Element A, factor 6
• MBHO: CR 3, Element C, factor 6

Refer to the FAQ on the look-back period for Medicaid Sanctions related to standards:

• CRPN: CRA 4, Element B, factor 2; CRC 12, Element B, factor 1
• MBHO: CR 5, Element A, factor 1

Actions To Take Now

• Monitor for further guidance from NCQA concerning the actions to be implemented after April 30, 2025.
• Contact your organization’s Legal department for any State-specific direction.
• Let your MHR Consultant know how we can assist.

References

New Guidance: Modifications to Scoring for NCQA Accreditation Surveys (February 17, 2025. ncqa.org)

Scoring Modifications (February 17, 2025. ncqa.org)

MHR implements a thorough quality review process for all blogs. This blog features insights from Sonia R. Frazier, MPH, CPHQ, MHR Consultant. Learn more about Sonia and MHR’s other Independent Consultants at managedhealthcareresources.com/AboutOurConsultants.