Accreditation 99 At-A-Glance

o What it is.

New standards from the National Committee for Quality Assurance that will tie performance on clinical, satisfaction, service, and access measures to accreditation. Accreditation 99 also added a new designation of "excellent" and changed the format of reporting plan performance to address consumer needs.

o New consumer protections.

- Prohibit plans from using financial incentives to encourage managers to limit or deny care.

- Require plans to have a process for approving exceptions to restricted drug formularies.

- Include an evaluation of whether plans unduly limit access to emergency department care.

- Require plans to coordinate medical and behavioral health care.

o Performance measures.

- Will count for 25% of the accreditation score.

- Will be compared against national and regional averages and national benchmarks (or best performers).

- Must be audited according to the standards of NCQA's HEDIS Compliance Audit program.

List of performance measures

o Clinical measures.

- Childhood immunization status.

- Adolescent immunization status.

- Breast cancer screening.

- Cervical cancer screening.

- Prenatal care in the first trimester.

- Advising smokers to quit.

- Beta-blocker treatment after a heart attack.

- Eye exams for people with diabetes.

- Checkups after delivery.

- Follow-up after hospitalization for mental illness.

- Flu shots for the elderly.

o Non-clinical measures.

- Getting care quickly.

- Doctors who communicate.

- Courteous and helpful office staff.

- Easy to find a personal doctor or nurse.

- Getting needed care.

- Claims processing.

- Customer service.

- Rating of personal doctor or nurse.

- Rating of specialist seen most often.

- Rating of health care in the past 12 months.

- Rating of experience with health plan.

o Comment period.

NCQA is accepting comments on the standards through May 15.

To receive a copy of the standards, contact the NCQA customer service center, 2000 L St., NW, Suite 500, Washington, DC 20036. Telephone: (202) 955-5697. Or you may download them from NCQA's World Wide Web site: http://www.ncqa.org/99draft.htm.

NCQA will accept written comments only via regular mail or through e-mail: [email protected].