MHR Newsletter
Driving healthcare quality one NCQA accreditation at a time
2024 #4
April 9, 2024
By: Nancy Ross Bell
From SusanÂ
MHR is privileged to work with numerous clients for NCQA Accreditation. Some prefer us to guide them every step of the way, while others prefer a "DIY" (do-it-yourself) approach, and still others fall somewhere in between.
We recently encountered a situation in which a client felt they had all their necessary documents, only to discover during our Gap Analysis that having the documents did not mean meeting the standards! Where do you stand? Our Gap Analysis is a comprehensive project management tool that shows exactly where you stand on NCQA requirements and where to prioritize your next steps. Decrease your uncertainty and know your risks.
It’s not too late to register for our client-only training on April 12, 2024, at noon EST. One fee of $400 covers all employees. This training is focused on Health Plan and Behavioral Health standards and Health Equity (HE) Accreditation. MHR will focus on the recent NCQA surveyor training, Policy Changes, and Clarifications, along with issues with HE delegation that you should be aware of prior to and during your preparation for HE accreditation.
April 24, 2024, is a special day when we recognize Administrative Professionals. MHR appreciates Viet Nguyen, who is crucial in supporting me and the consultants behind the scenes!
Read about our upcoming OFFER, a highlight of MHR’s CONSULTANT, Debbie Warren, and a PCS question on CR 7 under QUALITY INSIGHTS!Â
Â
As always, let me or your MHR Consultant know how we can guide you along your NCQA journey.
Susan K. Moore, President & CEO
BE AMONG THE FIRST TO TAKE ADVANTAGE OF MHR’S UPCOMING OFFER
Over the years, we had heard from clients like you how our templates, such as the ones used for analysis, gave them the steps to follow to ensure compliance, frequently when staff was new, or organizations were new to NCQA Accreditation, and the use streamlined their work across multiple accreditation teams. Having tools and templates in place when you need them saves you time, helps you plan for your training needs, and promotes staff competency. Plus, knowing the costs helps with budgeting.Â
Soon, both our clients and non-clients will have the opportunity to purchase MHR’s proprietary tools, templates, and training from a list online through our website. These items, which were previously only available during our consulting engagement, will now be accessible to a wider audience. We are confident that these resources will greatly benefit your NCQA Accreditation preparation along with our expert consultation. Get ready for a new level of convenience and efficiency!Â
Our tools, templates and guidelines are primarily targeted to health plans, but many can also be used for single products such as Utilization Management Accreditation and Credentialing Accreditation and can be used for MBHOs as they are similar standards but different numbering.
Our consultants review and update these documents annually with NCQA’s Policy changes, the standards updates, and other tips that they have found helped other clients.
MHR’s Health Equity (HE) templates and tools are in their final approval state and should be available soon. These can be used whether you’re a health plan, MBHO, hospital system, or other accreditable entity submitting for HE. We are also excited to soon roll out our two updated suites on Population Health Management and Delegation. These highly valuable comprehensive suites will give you all the tools, templates, and guides you need! We’ll notify you when they are ready.
Until our new automated purchasing system is ready, we are making the same items available by email so that you do not lose ground with requirements and are prepared for the 2025 changes in standards. Look for an upcoming email with directions.
 If you are not a current client, please reach out to Susan to schedule a Discovery Call and learn how we guide organizations on their path to NCQA Accreditation. Â
 MHR CONSULTATION + TOOLS + TRAINING = NCQA SUCCESS
GET TO KNOW MORE ABOUT
DEBBIE WARREN MHA, BSN, RN, CPHQ
When Debbie first moved into healthcare consulting in the mid-80s with a “big 8” accounting firm, she wasn’t sure at first that this was the type of work for her. However, facing less structure and multiple projects across different areas turned out to be exactly the type of work she now thoroughly enjoys as a Consultant with MHR!
One attribute of MHR consultants is they have all led organizations through NCQA Surveys, which is how Debbie first met Susan Moore. Several years after successfully bringing her health plan through an NCQA Survey, Debbie decided in 2019 to join up with Susan as a consultant.Â
Â
As a registered nurse, she primarily guides clients on the clinical aspects of UM, PHM, and QI 3-4 but also covers other areas when needed. What is most fulfilling for her is helping MHR clients achieve successful survey outcomes.
Because MHR Consultants work a flexible schedule, Debbie is able to do things she likes to do personally while still helping to ensure clients reach success by providing the in-depth review and feedback clients expect from MHR. Not only does she compare documents to NCQA standards to identify gaps, but when needed, she will assist and guide clients in developing their documents.
Although clients may at times resist what she knows is needed to comply with standards, Debbie is steadfast in advising organizations what the requirements are and what the risk is for not meeting them. What is challenging for all the consultants is when clients do not access MHR services until late in the process, sometimes six to nine months before document submission or during the lookback period for file reviews rather than before. Or, after an organization submits its survey, if it refrains too long from reviewing the updated standards against its documents, important information that must be addressed is often missed.Â
In spite of working fewer hours, Debbie maintains her knowledge base of the standards while working as an MHR Consultant. She assists with annual updates to the MHR library of tools, templates, and training programs and gladly pitches in wherever help is needed.
She enjoys working with Susan and her colleagues at MHR the most. She compliments their depth of knowledge about NCQA and the collaborative approach to addressing challenging client situations or questions. Like many close-knit groups, developing friendships along the way has been rewarding.
Being a consultant allows Debbie work-life balance to tackle new activities that “keep her on her toes” and her “brain active”! As she explains, she “needs to keep busy,” as evidenced by helping her two children, their spouses, and three grandsons, with another grandchild on the way!  Â
One of Debbie’s goals is to travel all the continents, and she is close to meeting that goal when she and her husband visit Australia later this year. Hiking the trails in Spain, trekking the mountains in Africa, and sailing the Caribbean are among the top places they have visited.
Back in Debbie’s hometown north of Atlanta, she stays active playing tennis, pickleball, and golf, walking three to five miles two to three days a week, and hiking when opportunity permits. She has recently learned to play Mahjong and Bridge and socializes with monthly games of Bunco and participates in a Book Club. Whew!
Read more about Debbie and our other Consultants on MHR’s website.
NEWS
Rapid Rise in Syphilis Hits Native Americans Hardest
Dozens of Health Plans Ask CMS to Crack Down On Medicare Advantage Denials
Using a New Payment Model to Integrate Primary Care Into Specialty Behavioral Health Settings
Medicaid News Recap-February 2024
Top Leaders’ 10 Predictions on “The Next Big Thing in Health”
11 Top Takeaways From Government, Health Leaders in Baltimore
Health Insurance Providers Continue to Support Patients, Providers Following Cyberattack
 QUALITY INSIGHTS
We asked NCQA for you!
 Read what NCQA’s Policy Clarification Support (PCS) advised when MHR posed the question about CR 7 for one of our clients.
CR 7 Assessment of Organizational Providers
Element  A: Review and Approval of Provider
What happens when a member is directed to receive care by an organizational provider at home?Â
Is a provider who renders services at a member’s home within the scope of review by NCQA for credentialing of organizational providers?
Please see NCQA’s responses to this organization’s questions.
NCQA defines a provider as an institution or organization that provides services (e.g., a hospital, residential treatment center, home health agency, rehabilitation facility, pharmacy). (Appendix 5 – Glossary)
Q: Ambulance transportation companies that provide ALS and BLS services to members.
A: NCQA does not require ambulance service providers to be credentialed; however, if an organization contracts with an ambulance services provider, then it would fall within the scope of CR 7. Under Element A, the organization must demonstrate that it has written policies and procedures for the initial and ongoing assessment of providers with which it contracts. Please note that NCQA limits its review of an organization's assessment of providers to the types listed in CR 7, Elements B and C.
Q: Courier services who pick up and deliver supplies but do not have direct patient contact or provide in-home care services
A: Â NCQA does not consider a courier service to be an organizational provider under CR 7.
Q: Non-emergent patient transportation companies that provide non-clinical transport for members via wheelchair vans and similar vehicles
A: Â NCQA does not require non-emergent patient transportation companies to be credentialed; however, if the organization contracts with this kind of provider, then it would fall within the scope of CR 7. Under Element A, the organization must demonstrate that it has written policies and procedures for the initial and ongoing assessment of providers with which it contracts.
Q: Laboratory services companies who process and deliver results of various specimens but do not have patient contact or provide in-home care services
A: In this scenario, the laboratory services company would be within the scope of CR 7 if the organization contracts with the facility and directs members there for services.
Q: Medical supply companies who ship supplies directly to members' homes but do not have direct patient contact or provide in-home care services
A:Â A medical supply company would be within the scope of CR 7 if the organization directs members to the company for services. If the organization does not direct members to the entity for services, it would not be in scope.
Q: Meal delivery services that deliver medically tailored meals and ad-hoc grocery needs to members but do not have direct patient contact or provide in-home care services
A: Â A meal delivery service would be within the scope of CR 7 if the organization contracts with the facility and directs members there for services.
Is your organization directing members to receive care by specific providers? Do you hold contracts with these providers?
News from NCQA:
Top Takeaways From the Health Equity Forum
Cross-Sector Collaboration: New Research and Recommendations
NCQA’s Kidney Health Tool Kit
Keep updated with MHR’s Blogs!
We had you in mind when writing our recent blog on file review!Â
Be Confident in the Driver’s Seat with NCQA File Reviews
Is there a topic you would like to know more about? Email Nancy Rossbell.
Â
UPCOMING INDUSTRY EVENTS
April 12, 2024
MHR’s Client-Only Training – Save the Date
- Live Webinar
April 19-22, 2024
2024 National Conference American Case Management Association
- Nashville, TN
April 29, 2024
Comprehensive Nutrition Program Leads to Long-Term Behavior Change and Savings
- Webinar
May 1-3, 2024
RISE The Special Needs Plan Leadership Summit
- New York
May 29-30, 2024
CMS Health Equity Conference
- Bethesda, MD/Virtual
June 2-4, 2024
RISE Qualipalooza 2024
- Atlanta
- Las Vegas, NV
August 9, 2024
MHR’s Client-Only Training – Save the Date
- Live Webinar
September 9-11, 2024
NAHQ Next 2024
- Virtual
October 31-November 2, 2024 -Save the Date- MHR Client Dinner on 11/1
NCQA Health Innovation Summit
- Nashville, TN
December 13, 2024
MHR’s Client-Only Training – Save the Date
- Live Webinar
 2025
October 13-15, 2025
NCQA Health Innovation Summit 2025
CALENDAR OF OBSERVANCES
Have you made plans to increase awareness of these observances?
April
National Infant Immunization Week (April 21-27)
May
National Nurses Week (May 6-12, 2024)
National Hospital Week (May 12-18, 2024)
Melanoma/Skin Cancer Detection Month
Osteoporosis Prevention and Detection Month
High Blood Pressure Education Month
June
Men’s Health Week (June 10-16, 2024)
National Cancer Survivors Day (June 2, 2024)
July
MHR was incorporated in 1991 and specializes in preparing organizations for all NCQA accreditation and certification products.
All MHR consultants were responsible for NCQA accreditation in their previous roles before joining MHR as an independent consultant. Most consultants are also NCQA surveyors and the majority are clinicians. Read more about How We Work!
We welcome hearing from you! Please get in touch with us.Â
Contact Us