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1. SNP 1 Care Management and Coordination Element A Documented Processes Element B Documented Processes Element C Documented Processes AND Reports OR Materials Element D Documented Processes AND Reports OR Materials Element E Reports AND MAY PROVIDE Documented Processes Element F Reports AND MAY PROVIDE Documented Processes Element G Reports AND MAY PROVIDE Documented Processes SNP 2 Improving Member Satisfaction Element A for each factor Documented Processes AND Reports Element B for each factor Documented Processes AND Reports Element C for each factor Documented Processes AND Reports SNP 3 Clinical Quality Improvements Element A Reports SNP 4 Care Transitions Element A for each factor Documented Processes AND reports OR materials Element B for each factor Documented Processes AND reports OR materials Element C for each factor Documented Processes AND reports Element D for each factor Documented Processes AND reports Element E for each factor Documented Processes AND reports Element F for each factor Documented Processes AND reports OR materials SNP 5 Institutional SNP Relationship with Facility Element A Documented processes AND reports OR materials Element B Documented processes AND reports OR materials Element C Documented processes AND reports SNP 6 Coordination of Medicare and Medicaid Coverage Element A Reports AND MAY PROVIDE documented processes OR materials Element B Doc
2. A https fiss ncga org ROSat ATCheckComplete asp Completeness Check The following elements for the evaluation option s you selected are incomplete Please check your data entry to Elements that are not Survey Tool ensure these elements are complete complete will appear here If you have sucessfully This section include re completed your survey tool the list will look like the tabs above orga Structure amp Process this the Structure close this window elements that the scope of 2002 2012 by National Committee for Quality Assurance Patent Pending the data sour additional exd Use of this Web site application constitutes acceptance of the License Agreement and Privacy Policy This dynamic Surve evaluate yourself ju documentation and to begin the formal el You may access a d Glossary are highlig by clicking on the A symbol 41 Screenshot 10A Submit survey tool MENT LIBRARY PRINT E u s HOME WHAT SNEW SEARCH HELP amp INSTRUCTIONS LOGOUT RESULTS APPENDICES INDEX When your organization is ready to submit this survey tool go back to Setup Survey Tool and edit the Evaluation Options Setup Survey Tool UP MENU UNI Select Product Line Product You must specify one or more Product Line Product because certain Standards and elements collect data specific to each Product Line Product In this section you select the Product Lines Products to
3. Screenshot 10F Submit survey tool a Confirmation of Completed Survey Tool Submission Microsoft Internet Explorer Survey Tool Submission Confirmation SETUP MENU RODUCT LINE PRODUC onfirmation of Completed Survey Tool Submission Your Survey Tool has been submitted Thank you This page confirms that your survey tool Submission Completed Thank you for submitting the Survey Tool to NCQA and for participating in the NCQA survey process A copy of your assessment and documentation has been successfully transferred to NCQA Please print this screen for your records has been submitted The project number for this survey 15 9606 What Happens Next When you next log in to the Interactive Survey System a section titled NCQA Suey and Results appears on the Welcome page The NCQA Survey and Results section includes a read only copy of the assessment and a listing of documents you have submitted including the project number assigned above For details on th Policies and Pro ges of the survey process and how to access the Survey Tool during the process please see the dures for the applicable accreditation certification or recognition program Your original version of the Suey Tool remains available to you ta continue the ongoing process of quality im prove ment We look forward to working vath you in the coming weeks If you hara any questions regarding ihe suray process please contact your assigned NCQA conta
4. Select to Submit for Survey column You may revise these selections at any time during your readiness evaluation i Survey To Select for o Submit fo You should select the Evaluation Option E appropriate box under Select to Submit for Survey You may select any one of the following evaluation options depending on whether you Returning SNPs Not Complete 7 z are a new or retuming SNP Not Complete c close this window Hew SNPs 2002 2012 by National Committee for Quality Assurance Patent Pending Use of this Web site application constitutes acceptance of the License Agreement and Privacy Policy 42 Screenshot 10C Submit survey tool PRINT M Y U HOME WHAT S NEW SEARCH HELP amp INSTRUCTIONS LOGOUT OR SURV 3 3 S APPENDICES GLOSSAR INDEX ISEUN URVEYTOOL E y APPENDICE You are now ready to submit SPECIAL NEED You can submit this survey tool from the link at the top of the Evaluation Survey Tool Google Chrome ions windo the bl a ni A Paidel Survey Tool amp https fiss ncga org RDSat ATManageEvaluationProducts asp Select Evaluation Options To enter the Survey To ETUP MENU UNIT OI ENT EVALUATION OPTIONS SUBMIT SURVEY TOOL u This section includes all t Instructions the tabs above organize tl To conduct a readiness evaluation and undergo survey you must select frorn the evaluation options Structure 8 Process meat below For additional informatio
5. NCOA Once the survey tool has been submitted you designed our electronic format to may view the information submitted to NCOA The facilitate understanding of our survey tool will not contain the results of NCQA s standards and make our survey evaluation To view the preliminary or final results of process more efficient the NCQA survey scroll down to Survey amp Results For any NCQA evaluation program you can purchase Select your SNP plan either of two components of the Margaret E O Kane benefit package to enter SNPs Interactive Survey System The President NCQA e correspondin first component Standards and survey ua y 2012 SNP Survey loo Web based 14 users Guidelines presents the details of our programs in a searchable layered format via the Web Using the second component the Survey Tool which has the Standards and Please select one to use Administration Guidelines embedded in it you can evaluate your performance Click on the link below to enter the administrative area against the standards as NCQA will evaluate it and you can prepare for an NCQA survey When you are ready the Survey Administrative Functions Tool becomes the basis for the NCQA survey You complete the Survey Tool attach necessary documentation and submit Change User Password both to NCQA Using the Survey Tool allows you to fully understand how you meet the standards and allows NCQA to conduct surveys economically and eff
6. Click on the link below to enter the administrative area Administrative Functions gt Change User Password HOME Welcome to NOQA s Interactive Survey System which contains all the information necessary for understanding and undergoing an NCQA Accreditation Certification or Recognition program Weve designed our electronic format to facilitate understanding of our standards and make our survey process more efficient For any NCQA evaluation program you can purchase either of two components of the Interactive Survey System The first component Standards and Guidelines presents the details of our programs in a searchable layered format via the Web Using the second component the Survey Tool which has the Standards and Guidelines embedded in it you can evaluate your performance against the standards as NCQA will evaluate it and you can prepare for an NCQA survey When you are ready the Survey Tool becomes the basis for the NCQA survey You complete the Survey Tool attach necessary documentation and submit both to NCQA Using the Survey Tool allows you to fully understand how you meet the standards and allows NCQA to conduct surveys economically and efficiently with most of the survey occurring off site The Help section above directs you to assistance NCQA offers about our programs Please contact customersupport ncga org to let us know how van like aur anlina farmat and if thara ie
7. Document to the Library Look For Link to Element I l You can search by dod For example docx Document Name Documented Process SNP 4 Element A Relevance Level Primary v If you need to see all docume Document File Path Documented Process SNP 4 Element A pdf Standard Document N Please pick an element to link SNP4 Element A w Add Link Unlink Unload Element Clickto View Document Save and Close Save and Link More Elements Cancel and Return to Document Libra Not Linked Documented Make sure to selectthe _ hlink Unload Element you are linking the document to and then to save 2002 2012 by National Committee for Quality Assurance Patent Pending Use of this Web site application constitutes acceptance of the License Agreement and Privacy Policy Screenshot 8A Log out CUMENT LIBRARY PRINT SU SURVEY TOOL UTILITIES HOME WHAT S NEW SEARCH HELP amp uc 3 LOGOUT POLICIES RESULTS APPENDICES G INDEX amp PROCEDURES peuk PURS DE Remember to always logout when you are Special Needs Plans a your This category includes the following Standards SNP1 Complex Case Management Elements A B C D E E G H I J K P2 Improvii e Satisfaction Elements A B C Clinical Quality Improv Elements A SNP4 Care Transitions Elements A B C D E E SNPS Institutional SNP Relationship With Facilitv 40 Screenshot 9A Completeness check WENT LIBRA
8. NCQA Measuring quality Improving health care 2013 ISS TOOLKIT For the Assessment of Special Needs Plans SNPs Against the Structure and Process Measures Prepared by the SNP Team Brett Kay Casandra Monroe Sandra Jones Anthony Davis Nidhi Dalwadi Priyanka Oberoi Ling Chen Delia Ponce Contact SNP ncga org Vi VII SNP Reporting Key Messages Reporting Requirements by SNP Type Element Data Sources by Element and Examples of Data Sources Guidelines for a Successful Evaluation of a Special Needs Plan SNP Against the 2013 Structure amp Process Measures Preparing Documentation for Surveys Steps and Screenshots for Key Activities ISS Documentation Tips 10 17 19 28 30 48 50 NCQA Measuring quality Improving health care 2013 ISS Toolkit SNP Reporting Key Messages The following key messages are important and should be used to guide you through vour oraanization s readiness evaluation and the ISS tool submission process e If your organization has more than one Special Needs Plan SNP benefit package you must submit a separate survey tool for every SNP benefit package Use the name of the SNP H number and plan ID to identify the correct survey tool e Prepare to submit ISS tool s early to avoid internet traffic delays but do not submit your ISS tool s later than October 15 2013 e Each SNP survey tool has a 1 4 person user license Your organization s ISS administra
9. by NCQA SNP structure and process measures The organization may not allow a third party to use the Survey Tool it has licensed to evaluate another organization against NCQA SNP structure and process measures Ihave read and understand the above statement Read the statement and click a here to proceed 2002 2013 by National Committee for Quality Assurance Patent Pending Use of this Web site application constitutes acceptance of the License Agreement and Privacy Policy 47 Screenshot 11E View final results PRINT HOME WHATS NEW 2013 Special Needs Plans Structure amp Process Measures Select an evaluation option for which to view results Name Special Needs Plans Structure amp Process Measures comp for CMonroe4 Evaluation Option New SNPs Your evaluation option Returning or New SNP will appear here Click on BORD RE 20 this link to view your results Valid Dates Not Available Footer on some results pages Screenshot 11F View final results SURVEY TOOL RESULTS APPENDICES GLO amp PROCEDURES amp GUIDELINES BACKGROUND SUMMARIZED amp COMMENDATIONS DETAILED RESULTS RECOMMENDATIONS 2013 Special Needs Plans Structure amp Process Measures Note Any elements that are incomplete are scored at 0 00 These are your results scroll down To view the Survey Tool click on the link to the right of the Standard you wish to view 5 to view the rest of your scores To return directly to
10. by providing a documented process and reports materials that show it helps members understand the states adjudication of claims submitted by providers Element 6C is not applicable N A for all Dual Eligible SNPs and Chronic and Institutional SNPs with fewer than 5 dual eligible members however Chronic and Institutional SNPs must provide documentation to support the N A claim and NCQA will verify with enrollment data from CMS Elements 6D and 6E are not applicable N A for Chronic condition and Institutional SNPs with fewer than 5 dual eligible members are not required to report however you must provide documentation to support the N A claim and NCQA will verify with enrollment data from CMS For security reasons including the protection of the data and documents you send to us we limit the types of documents you may send The permitted file types are CSV DOC DOCX GIF JPG MPP PDF PPT PPTX RTF TXT VSD XLS and XLSX We cannot accept files in other formats Please note that most other formats can be converted to GIF or JPG via scanner or to PDF using Adobe Acrobat Please do not attach documents that contain Protected Health Information PHI to the 17 18 NCQA Measuring quality Improving health care Preparing Documentation for Surveys An important part of any NCQA survey is document preparation NCQA determines if an organization meets an element or factor based on what t
11. comp for CMonroe4 License 18458 Submitted 7 25 2013 2012 SNP Structure 8 Process 2012 comp for CMonroe4 License 18140 2011 SNP Structure 8 Process 2011 comp for CMonroe4 License 17825 Surveys 8 Results We have conducted or are conducting the following surveys 2008 SNPS 2009 SNPS 2010 SNPS 2012 SNPS 2013 SNPS Administration e Change User Password Inactive Projects Click on the Inactive Projects link listed below to view inactive projects e Inactive Pi ts 46 Screenshot 11C View final results STANDAI ORGANIZATION SURVEY T amp GUIDELINES BACKGROUND 2013 Special Needs Plans Structure amp Process Measures Welcome to the Interactive Survey System The information in the following sections includes Click Results the complete Structure amp Process measures e information about how your organization will be evaluated against the Structure amp Process measures e policies and procedures We designed the system to facilitate understanding of our Structure amp Process measures and the evaluation process The Help and Instructions section above directs users to assistance Policies and Procedures This section provides an overview of the survey option you have selected it describes the goals and principles that guide our approach to evaluation and provides a high level summary of areas addressed by the Structure amp Process measures The Policies and P
12. each other Ifthe organization supplies numerous documents without an explanation it is difficult for the surveyor to synthesize how the documents together may demonstrate it meets the intent of the element or factors Reference the key documents that demonstrate your organization s performance with the specific element and or factors Please remember to specify the document and specific pages or sections that contain this evidence The documentation guide does not have to be lengthy just a concise description of how the organization meets the specific requirements of the element and or factors A few examples are provided below for guidance only 24 Example 1 Documentation Guide for SNP 4 Element D 2013 S amp P Measures The organization identifies transitions by reviewing the following for facilities in its network 1 Reports of hospital admissions within one business day of admission 2 Reports of admissions to long term care facilities within one business day of admission In 2012 Smart Health Plan SHP incorporated language in its provider contracts requiring acute care hospitals SNFs and long term acute care facilities to notify it of an unplanned admission within 24 hours In addition to excerpts from the contract SHP has supplied evidence consisting of a policy for its staff to download and review daily census reports and three of these reports containing information on unplanned admissions to acute an
13. include in the Survey Tool You may revise your choices any time prior to submitting the Survey Tool the tabs abo Select Evaluation Options In this section you select the evaluation products you wish to use Structure amp H The Survey Tool will reflect your selection and will automatically include the applicable Standards You may revise your choices any time prior to submitting the Survey Tool To formally begin the survey process you must submit an application for survey that includes the license number for your Survey Tool We will work with you to confirm your application and set a submission date for the Survey Tool and any documentation Your survey commences when you submit the Survey Tool at which point we consider any documentation attached to be final The Policies and Procedures provide complete details of the application and survey processes close this window by clicking on the A symbol Screenshot 10B Submit survey tool Select Evaluation Op ETUP MENU UNIT EY TOOL Instructions To conduct a readiness evaluation and undergo survey you must select from the evaluation options below For additional information on selecting evaluation options click on the instructions link above To select evaluation options for readiness evaluation check the box for the product s in the Select for Readiness Evaluation column To select evaluation options to submit for survey check the box for the options in the
14. procedures and training for providers and multidisciplinary care team members to conduct analyses of its care transition activities Its tools consisted of audits of data generated from a Patient Transfer Form developed by a state patient safety task force This task force included substantial representation from major hospital systems health plans and providers To demonstrate its performance with factors 1 through 4 of SNP Element C Star Health Plan incorporated the following into one comprehensive overarching document e A report containing an analysis of a sample of care transitions for the first six months of 2013 based on data from the audit pages 1 4 e Care Transition Management Policy CTM 0 50 which describes the plan s processes for performing the transition management activities for SNP 4 Elements A and B and the subsequent analysis for Element C pages 5 8 e Star Health Plan s audit procedures accompanied two completed audit tools one for factors 1 and 2 of SNP 4 Element A and second one for factor 3 of SNP 4 Element A and factors 1 through 3 of Element B pages 9 12 and e A copy of the Patient Transfer Form Star Health Plan and its providers use for member transfers from one care setting to another page 13 Key points about this example The organization has addressed all key requirements of this element in the documentation guide above The organization provided a documented process reports and some
15. respective element in the survey tool You can prepare one document for each measure addressing all the elements in the measure in that document If this method is used NCQA suggests that you name your documentation guide specific to the measure and element that it supports e g Documentation Guide for SNP 1 or use a name that conveys what the document contains Incorporate the section of the documentation guide in the support text notes box for each respective element in the survey tool Format for a Documentation Guide NCAA is not prescriptive regarding the format for the documentation guide however some general recommendations are provided below Specify how the documentation supplied demonstrates performance with the requirements of the element or factor Because your organization is familiar with its own processes it may seem apparent how documents demonstrate performance within the context of the element or factor However the surveyor has limited familiarity with an organization s operational processes and therefore it is important to provide a foundation for how the documentation supplied meets the performance requirements of the specific element or factors Documentation guides are especially helpful when you need to provide more than one document If more than one document is necessary incorporate information in the ISS support text notes field or in a summary document explaining how the documents relate to
16. this page from the Survey Tool use the Back button on your browser SNP1 Care Management and IIS View Coordination SN Survey Tool Element A Element B Element C Element D 48 49 NON 0 DU Buona ISS Documentation Tips Maintain documents on a shared drive Consider creating folders for each Structure and Process measure Establish a system for version control Name documents clearly your audience is both internal staff and surveyors Avoid characters such as ampersand 8 apostrophe or semicolon Avoid duplicate names Use common file types such as doc Word documents xls Excel documents ppt Power Point pdf Adobe PDF gft jpg Do not send exe executables Documents that you do not have electronically can be scanned and converted to PDF GIF or JPG Consider including only relevant pages of a large document with a copy of the document cover page on top Consider converting your final Word or Excel documents to PDF format or making them read only to ensure no changes will be made Try using legal line numbering as on the left of this page to identify areas that demonstrate performance remember this may change your pagination Highlight key sentences or areas of your documents to call the surveyor s attention to that area Insert a hyperlink if necessary to demonstrate compliance by either copying the url httos iss ncga org RDSat ATLogin asp or by using t
17. 001 4 Please include any additional market names plan names or other ways in which this SNP is referred to in the organization s documentation You may attach additional documentation for this response if so desired NCQA Health Plan of Washington D C was established in 1990 As a federally ES Please include any additional qualified and state certified 501 c 4 not for profit HMO our goal is to market or plan names as well provide high quality comprehensive and cost effective health care to the 3 as a short description of the residents of Washington D C Virginia and Maryland SNP The NCQA Health Plan is Washington D C s first and largest HMO Our extensive Y provider network includes nearly 4 000 physicians 63 hospitals and a national 5 Please include the names of affiliated SNP plans that operate under the same corporate structure parent organization You may attach additional documentation for this question SNP Type i e dual chronic institutional 6 Ifthis is a Chronic care SNP please include the diseases or conditions covered by this benefit package you may attach additional documentation to respond to this question Y ttach additi i ou may attach add t ona documents here Save Update Organizations may attach information or materials about the SNP benefit package that provide additional background information however this is optional and not required Load Document to the
18. 012 CMS Comprehensive Report will receive a score of not applicable N A SNP 4 Element A Policies and procedures detailing the organization s Please note that two data sources e g documented processes and reports materials are required for each factor of every element in SNP 4 process for identifying and managing planned unplanned transitions between care settings which include timeframes for specified activities Policies and procedures with specified timeframes that show how the SNP notifies the member s usual practitioner of a transition Element B Procedures with specified timeframes that demonstrate how the SNP communicates changes in members conditions to member and or responsible party and how the SNP educates member and or responsible party regarding the transition process Element C Reports demonstrating aggregate analysis of performance managing transition tasks Element D Policies and procedures for reporting by contracted entities Element D Reports on daily admissions or staff notification of transitions Element E Reports detailing an analysis of admissions and ER visits which indicates how the SNP implements an intervention to reduce unplanned transitions 15 Elements C and E require documented processes and reports For Elements C and E SNPs with no members at the start of the look back period may select not applicable N A however you must pro
19. Document File Path Document Library Use the Browse button to locate the document required Save and Close Save and Attach More Cancel and Return to Document Library close this window Screenshot 7D Document Library linking or unloading documents Document Library Instructions Your document library has links to 7 document s in Survey Tool Look For Select Standard s All Load Document to the Library You can search by document extension part of or full Linked document name or path be ON Ari reat MyDocument ISNP2 Link your documents to gt SNP3 the relevant elements Remove documents from Document Library Standard Element n Not Linked Document Name File Path Click to View Click to Edit Link Document T 1 G NCQA Survey Outstanding 07 22 2013 Add Unlink Unload Issues Form 2012 0C05201 Link UM 3 and 11 for conf call docx ne 2 a _ mangas A A em ws Link O ol A O dl 2 O ae st a Link Outstanding Issues Not Linked BE SNP1 C 39 Screenshot 7E Document Library linking documents OrderBy 8Gearct tWhat 8SortC A https fiss ncqa org Ncga Iss Document Web Link lement as Link Document to Element 10729048D0cMetaDatalD 6430578D0What Add8Message None Document Library Instructions Instructions n Load
20. Library close this window 2002 2012 by National Committee for Quality Assurance Patent Pending Use of this Web site application constitutes acceptance of the License Agreement and Privacy Policy 35 Screenshot 5A Set up survey tool PRINT SUBMIT SURVEY HOME WHAT S NEW SEARCH HELP INSTRUCTIONS LOGOUT TION SURVEY TOOL m RESULTS APPENDICES OR NDEX i INDE Untitled Google Chrome Once in your survey tool you should click here to set up your ETUP MENU UNIT survey tool Special Needs Plans Select Product Line Product You must specify one or more Product Line Product because certain Standards and elements collect data specific to each Product Line Product In this section you select the Product Lines Products to include in the Survey Tool You may revise your choices This category includes the following any time prior to submitting the Survey Tool You will need to select your Evaluation Option here to e lu In this section you select the evaluation products you wish to use indicate if this is a new or omplex The Survey Tool will reflect your selection and will automatically include the applicable Standards returning SNP plan benefit You may revise your choices any time prior to submitting the Survey Tool package Submit Survey Tool To formally begin the survey process you must submit an application for survey that includes the license number for your S
21. Next Standard button 3 For each supporting document listed you must e identify the page number containing the information that supports the factor or element as specified in the Survey Tool e attach only pages and sections necessary to demonstrate how your organization meets the measures as well as any cover page that identifies the document and if applicable provides its date If you reference a document multiple times you may place the entire document in the document library and reference different pages and paragraphs throughout your assessment If you wish to stop using the Survey Tool click on the Log Out button located on the Navigation Bar You should log out even if you only plan a short break This will properly notify the system that you are done with your session If you do not log out the Survey Tool will time out after 30 minutes of inactivity 12 NCQA Resources Online Support NCQA s SNP Web page http www ncga org snp contains a wealth of information that includes recent news from NCQA the Policy Clarification Support PCS system policy clarifications and updates and slides and audio recordings of SNP trainings pcs Send any questions about interpretation of the Structure amp Process measures through the PCS system on the NCQA Web site at http ncga force com pcs login FAQs are available on the SNP page of NCQA s Web site FAQs http www ncga org sn 13 Recommended Supporting Docume
22. Online instructions above include all current functionality you navigate your ISS survey tool s User s Manual 3 8MB click here to access a user manual of all ISS features March 2012 Stendardcand your performance it and you can eady the Survey You complete ation and submit you to fully allows NCQA to with most of the survey occurring off site p section above directs you to assistance NCQA offers about our programs Please contact customersupport ncqa org to let us know how wan lika aur anlina farmat and ifthara ie any wav wa can firthar ISS Demonstrations ISS demonstrations use a tutorial software Once you click on a link below it will open a new browser window and automatically launch the demonstration You may stop the demonstration at any time additional instructions will be found inside the demonstration You will not be able to alter the speed of the demonstration Note Online demonstrations are updated periodically and may not cover recently added features Please note 34 Screenshot 4A Organization Information ORGANIZATION INFORMATION Organization Information Please include the following information for identification and verification purposes 1 Please include the organization name NCQA Health Plan 2 SNP Benefit Package Name NCQA Plan 3 Please include the organization H Number CMS Medicare Advantage contract number and SNP benefit package plan ID H1234
23. RY PRINT SUBMIT SURVEY TOOL UTILITIES HOME WHAT S NEW SEARCH HELP INSTRUCTIONS LOGOUT RESULTS APPENDICES INDEX Survey Tool Utilities Google Chrome https iss ncqa org RDSat ATUtiliti When you have completed filling out your survey tool proceed to Utilities Special Needs F The following utilities are available to help you review data in your Survey Tool Survey Tool Utilities Completeness Check i i Use the link below to check for any incomplete elements for the evaluation option s you selected Please check your survey This category includes the tool for Completeness Completeness Check Support Text Notes Use the link below to view a single page with data from all elements to which you have access rights e View all Evaluations click here to view your evaluation comments from all elements View all Organization Private Notes click here to view the private notes from all elements View all Comments click here to view all your organization s comments to the preliminary results from all elements Note If your organization has not completed this stage in the survey process or this step is not applicable to your survey process you will be unable to access this data See your Policies and Procedures for more details on survey stages ran Elements A B C D E E SNPS Institutional SNP Relationship With Facilitv Screenshot 9B Completeness check SURVEY TOOL y Completeness Check Google Chrome
24. a documentation guide the organization can provides additional background on the measures or tell its story and can explain how the multiple documents relate to each other and in what order they should be reviewed Bookmarking effective highlighting and comments can eliminate the need for a documentation guide for many elements 28 29 Steps and Screenshots for Key Activities This section of the toolkit summarizes and illustrates steps and information organizations can use to perform certain activities in their ISS survey tools It provides a quick reference for logging into survey tools changing passwords loading documents to the library and conducting completeness checks Please consult the Interactive Survey System User s Manual in ISS for complete instructions and details on all ISS survey tool functions Getting started NCQA gives the Administrator for each SNP a temporary user ID and password which prompts the user to change the password the first time it is used Administrators should store their password in a safe place since they can grant up to 3 additional users access to the organization s survey tools 1 2 5 Rh W 9 Go to https iss ncga org you may want to bookmark this page Enter the user ID and password passwords are case sensitive Click log in Accept the license agreement access is not permitted if you do not accept Welcome page picture of Margaret O Kane Administrators ma
25. access a complete glossary ofterms by selecting Glossary on the menu Key terms in the Glossary are highlighted and identified with the FA symbol You may view a glossary definition at any time by clicking on the FA symbol Screenshot 6B ISS Survey Tool JEY TOOL UTILITI Special Needs Plans You are now in the survey tool This category includes the following Standards SNP1 Complex Case Management Elements A B C D E E G H 1 J K SNP2 Improving Member Satisfaction Elements A B C SNP3 Clinical Quality Improvements Elements A SNP4 Care Transitions Elements A B C D E E SNPS Institutional SNP Relationship With Facilitv 37 Screenshot 7A Document Library EYTOOL DOCUMENT LIBRARY PRINT SUBMIT SURV UTILITIES HOME WHAT S NEW SEARCH HELP amp INSTRUCTIONS LOGOUT NDARI DELINES survey TooL F N RESULTS APPENDICES GLOSSARY INDEX Once in the survey tool you can click on the Document Library to load and link Special Needs Plans documents This category includes the following Standards SNP1 Complex Case Management Elements A B C D E E G H 1 J K SNP2 1 Member Satisfacti Elements A B C SNP3 Clinical Quality Improvements Elements A SNP4 Care Transitions Elements A B C D E E SNPS Institutional SNP Relationship With Facilitv Screenshot 7B Document Library loading documents https fiss ncqa org nent Web DocumentL
26. additional evidence to support the requirements specified in the explanation e g the sampling methodology and data collected The organization notified the surveyor where the specific documents can be found This makes the review process more efficient for the surveyor when lengthy detailed or numerous documents must be reviewed 21 Are Documentation Guides Required The necessity of a documentation guide will vary based on the element and also on the degree to which the organization make use of other tools roadmaps bookmarking highlighting and comments to present a coherent story The following are examples of two elements where the need for a documentation guide differs SNP 1 Element E factor 1 Satisfaction With Care Management obtaining feedback from members requires a report showing the organization obtains feedback from its members in the care management program Because this is a straightforward requirement and a report is the only required data source to demonstrate performance it may not be necessary for the organization to provide any additional information regarding its documentation SNP 1 Element F Analyzing Effectiveness Identifying Opportunities requires the organization to demonstrate that it has used three measures to assess the effectiveness of its care management program and identified opportunities for improvement This may require several documents for each of the three identified opportunities Using
27. and select it using the Open button located on the 30 file look in prompt e scroll over the name of the document not the entire path f copy and paste the name of the document into the Document name field g click Save or Save and attach more documents 14 Remember to link documents to the appropriate element s in the Document library Linking a document to an element a Click Add Link to link documents b enter the page number s in Reference Pages c select the Relevance level from the available options d select the element to which you want to link the document to and e click Save and Close or click Save and Link More Elements if you would like to link this document to more elements To link another new document to an element repeat steps a through e Tip Always logout when you are finished working on your ISS tool screenshot 8A 17 15 Perform a completeness check before you submit your survey tool To check completeness a Click Survey Tool followed by Utilities b Select the Completeness check link c Review the Elements That Are Not Complete d double check each element and complete all that are listed as incomplete 16 To submit survey tool s After you have confirmed all information in the survey tool is accurate and you are ready to submit a Click on Set up the Survey Tool followed by Select Evaluation Options b Mark the checkbox for your SNP type under Select to Sub
28. anv waw wa can furthor Margaret E O Kane President NCQA Change User Password You have been brought to this page for one of the following reasons e You are a new user and all new users are required to change their password upon initial login e You are an existing user but your password does not meet current security standards e You are an existing user and have elected to change your password New passwords must be at least 8 characters in length and must also have 3 of the 4 following characteristics At least one uppercase character At least one lowercase character At least one numerical character At least one symbol i e 8 etc User ID Current Password Enter Your User ID and New Password Below PB12272027 E New Password Confirm New Password Save Update If you have forgotten your Password enter your User ID above and click here to continue 33 Screenshot 2A Welcome page select your survey tool Br NEW HELI Interactive Survey System Welcome to NCQA s Publications and Survey Tools Interactive Survey System which Your organization has licensed the following Web based contains all the information publications necessary for understanding and undergoing an NCQA In this section use the survey tools to complete your Accreditation Certification or organization s self evaluation prior to submitting to Recognition program We ve
29. asure SNP 4 Care Transitions Element A Managing Transitions Y Y Element B Supporting Members Through Transitions Y Y Element C Analyzing Performance Y y Element D Identifying Unplanned Transitions Y Y Element E Analyzing Transitions Y Y Element F Reducing Transitions Y Y Measure SNP 5 Institutional SNP Relationship With Facility Element A Monitoring Members Health Status Y Y Not for Chronic Duals Element B Monitoring Changes in Members Health Status Y Y Not for Chronic Duals Element C Maintaining Members Health Status Y Y Not for Chronic Duals Measure SNP 6 Coordination of Medicare and Medicaid Coverag Element A Coordination of Benefits for Dual Eligible Members Y Y Not for Chronic Institutional Element B Administrative Coordination for Dual Eligible SNPs Y Y Not for Chronic Institutional Element C Administrative Coordination for Chronic Condition amp Inst 2 BP 2 5 Not for Duals Element D Service Coordination a 2 Element E Network Adequacy Assessment yl yl EXCEPTIONS 1 Not applicable NA for a SNP that does not have any members at the start of the look back period NCQA will verify enrollment data with the April 2013 CMS Comprehensive Report 2 Not applicable NA for Chronic and Institutional SNPs with fewer than 5 dual eligible members Measuring quality Improving health care 2013 ISS Toolkit Data Sources by Element
30. ct directly or NCQA Customer Suppor at 868 275 7585 or customersuaporli neqs org Thank you again for participating in the NCOA sumey process Please click here to continue 44 Screenshot 10G Submit survey tool reditation certification or mission of ie Survey Tool Please contact Custorner Support at 668 275 7565 or cus application and submission with NCQA Retum to Survey Tool If you get an error message that says your organization has applied for a different evaluation option s than those identified in the survey tool you may have selected the wrong evaluation option new versus returning SNP in screenshot 10B 45 Screenshot 11A View final results NCQA Screenshot 11B View final results Interactive Survey System NEW Onine demonstrations under Heip 3 instructions for me Document Lerary Upgrade You must use your SNP 2013 User ID and password to log in and view your results From 117182012 8 30pm 10 10182913 5390m Af you have forgotten your Password enter your User ID above and click here to continue To purchase a license to access this system click here for details IMPORTANT NOTIFICATION The ISS document library was closed temporarily while we reviewed the system due to a report of an issue An error had occurred on document upload that affected one organization who has been noted This error has been addressed We apologize for tha ncomejenca Al ihr docume
31. cted reports arranging services e Information prepared daily monthly Procedures for for members e Redacted reports that ordering services from experiencing show predictive providers transitions modeling Contracts or e Benefit summaries e Reports on overall agreements e Marketing materials rates of admission especially for facilities e Instructional materials e Reports showing responsibilities with e Provider directory aggregate analysis institutional SNPs and e Provider manuals e Summary reports of administering Medicaid Newsletters analysis benefits to dual e System output giving eligibles information Procedures for network facilities to provide updates on members health Evidence of Coverage e Meeting minutes e Documentation of actions that the SNP has taken e Written notification of EOC scheduled meeting Models of Care with state or state MOCs acknowledgement of receipt e Reports on access indicators e Screen shots Actual reports required This list is not all inclusive NCQA Me asur es que Imp Jrovin g hea a Guidelines for a Successful Evaluation of a Special Needs Plan SNP Against the 2013 Structure amp Process Measures Welcome to the Structure amp Process Measures survey process The guidelines and resources contained in this document will help you prepare for your organization s survey and maximize the efficiency of your preparation time SNP Survey P
32. d long term care for the month For factors 1 and 2 of SNP 4 Element D please see the attached PDF document named 2013 SNP 4 Element D with bookmarks leading to a copy of Section 3 of the provider contract containing the specified information along with the first page of the contract showing the facility s name and a page containing specified language and the signature page for both entities Section 2 of Policy 2389 Facilitating Transition Support for Unplanned Admissions which describes how case managers and care coordinators download and review daily census reports each business day containing information on unplanned admissions to acute care and long term care facilities from its UM system These staff members subsequently use this information to contact members to address their care coordination needs Three daily census reports showing the effective and notification dates for unplanned admissions to acute and long term care facilities within the months of May June and July 2013 Key points about this example The organization has addressed all key requirements of this element in the documentation guide The organization addressed both data sources for this element documented process and reports NCQA requires the organization to supply its written procedures and evidence of implementation e g the explanation for this element specifies that three reports must be provided for hospitals and long term care facilit
33. e dark blue tool bar scroll down to ISS Demonstrations and click on Document Library Utilizing the available resources and following each of these steps are essential for successful preparation of your documentation for the submission process Completing the Survey Tool Print out and use the instructions in the Survey Tool which you can access by clicking the Help button on the Navigation Bar on the opening screen The Structure amp Process Survey Tool instructions appear on the next screen They provide all the information necessary to successfully navigate and complete the tool and complete your readiness evaluation As you assess your performance with each factor and element be sure to 11 1 Preload your document library with essential documents that demonstrate performance against the measures 2 Evaluate each element and load the appropriate document s that demonstrates performance by linking it to an existing library document or if necessary load a new document and link it by clicking the Add Link button Each factor and element must have supporting documentation If possible limit supporting documentation to no more than three documents per element For detailed instructions please refer to the section titled Steps and Screenshots for Key Activities which starts on page 30 be sure to view screenshots 7A 7E of this guide After entering a data element save it before moving on by clicking the Save button or the
34. e the organization must provide to meet the requirements Scope of Review The extent of the organization s services evaluated during an NCQA survey Look back Period The period of time for which NCQA evaluates an organization s documentation to assess performance against an element NCQA measures the look back period from the point of the organization s submission of the completed Survey 20 Tool Unless otherwise noted organizations must meet the requirement throughout the look back period Explanation Specific requirements that the organization must meet and guidance for demonstrating performance against the element Examples Descriptive information illustrating performance against an element s requirements Examples are provided for guidance only and are not specifically required or all inclusive Be sure to consider all pertinent information provided by NCQA under each measure and element in the Survey Tool e g each of the information sources described in the section above Ifthe data source specifies documented process and the organization provides a report it has not demonstrated full performance Likewise if the look back period specifies 6 months and the organization provides evidence of completion of the activities that is dated 12 months prior to the survey date then it has not demonstrated performance with the requirements Document Preparation NCQA surveyors serve as fact finders for organizations ve
35. ents factors Alternatively use a name that conveys what the document contains or means Both word processing programs such as MS Word and Adobe PDF support these features How Much Documentation is Enough or Too Much Carefully read the information and explanation contained under each element in the survey tool taking into account the data source s and the look back period Each element must have supporting documentation If an element is not applicable to your organization please supply supporting documentation and an explanation in the support text notes box for the element 22 Documentation that is supplementary in nature may make the survey process more complex than desired Organizations should apply a philosophy of minimum necessary information when preparing documentation Surveyors will seek additional information when they do not find evidence of performance in the documents presented 23 Documentation Guide A documentation guide is simply a concise document that describes how your organization meets the requirements of the specific element factor This guide helps the NCQA survey team to best understand your organization s processes and documentation within the context of the specific NCQA requirement Methods for Including Documentation Guides The following are two examples of methods that may be used 1 Prepare the documentation guide in a word or PDF document and load it under the
36. es SNP 6 Element A Reports that demonstrate how the SNP coordinates Medicaid and Medicare benefits and services Element A Evidence of coverage documents Element B Procedures and reports used to determine Medicaid eligibility and changes in members Medicaid eligibility 16 Elements B and C Instructional materials distributed to members or responsible parties on where to reapply for Medicaid Elements B and C Job descriptions procedures and scripts used by staff that assist members with information on Medicare and Medicaid eligibility benefits and claims Element C Procedures for administering Medicaid benefits and acknowledgment of receipt of instructional materials from state on how to administer Medicaid benefits Element D Policies and procedures for arranging services for members along with provider directories provider manuals Element E Policies containing standards for the numeric and geographical distribution of practitioners and providers as well as the methodology used to assess network adequacy reports showing an evaluation of network adequacy for practitioners and providers that accept members Medicare and Medicaid benefits Elements 6A and 6B are not applicable N A for Chronic condition and Institutional benefit packages An organization that does not have a contract with the state to adjudicate Medicaid claims can meet the intent of Element 6B factor 2
37. esignate each document as primary or secondary in the ISS Survey Tool If you are considering using the Supporting designation NCQA encourages the organization to consider if the document is truly necessary to demonstrate it meets the intent of the requirement NCQA strongly suggests that organizations use the following tools available in common software to prepare the documentation for the survey team Highlight or underline the key text in the document to draw the surveyor s attention to the sections that demonstrate performance Convert multiple documents into one document in pdf format and create hyperlinks or bookmarks in the document that automatically take the surveyor to highlighted text Use add comment tools to note the element and if applicable factor to which the highlighted section applies For very large documents provide only the necessary pages the cover page and any other pages that contain necessary dates NCQA strongly encourages that you use either scanned copies or Adobe PDF which allows you to extract pages from large documents while retaining the integrity of the page layout Name the document in a manner that helps the surveyor understand why it is relevant The name should be as specific as possible Where possible name the document according to the specific measure element or factor s it supports This may not be possible when you use the same document for multiple elem
38. he Insert function of Word or Excel Label drafts and final documents carefully to be able to distinguish between them Use the date feature in footers to keep track of last time you updated the document note that it defaults to updating every time you open the document whether you made changes or not Directions for legal line numbering in Word 1 On the File menu click Page Setup and then click the Layout tab 2 If you re adding line numbers to part of a document click Selected text in the Apply to box 3 Click Line Numbers 4 Select the Add line numbering check box and then select the options you want 50
39. he organization s documents such as policies program descriptions activity reports member materials and other work products demonstrate The documents show what you as an organization do How you prepare those documents and present them to NCQA in other words how you tell your story can make it easier for the NCQA survey team to confirm that you meet the requirements This can result in a simpler and more streamlined survey experience with fewer requests from the survey team for clarification or additional information during Plan Comment Your objective should be to provide the NCQA survey team with the information necessary to accurately evaluate performance against the Structure and Process S amp P measures in as directed and efficient a manner as possible Keep in mind that the goal of the surveyor is to confirm that your organization meets the intent of the requirements therefore the clearer it is that it has met the intent the easier it is for the surveyor to confirm the organization s performance However the organization is ultimately responsible for documenting its performance and directing the surveyor to that documentation The purpose of this document is to provide direction on preparing documents and developing a documentation guide which helps the surveyor navigate through the information attached to your survey tool lt has three sections How the S amp P Measures are Structured This section provides an over
40. iciently with most of the survey occurring off site The Help section above directs you to assistance NCQA offers about our programs Please contact customersupport ncqa org to let us know how won live aur anlina farmat and if thara ie any wav wa ran further Screenshot 3A Help amp Instructions and User s Manual Help Google Chrome ES https fiss ncqa org RDSat Interactive Survey System User Resources structionsTyp HOME WHAT S NEW HELP amp INSTRUCTIONS LOGOUT Instructions Instructions for the Standards and Guidelines and Sui Tool click here for instructions on navigating in the Standards and Guidelines and Survey Tool setting up the Survey Tool using the Survey Tool for evaluation document management and submitting the Survey Tool for survey Document Library FAQs Click here to review answers to commonly asked questions related to the Document Library User Manuals The Help amp Instructions link and User s Manual are resources to help User manuals are provided in Adobe Acrobat PDF Download times for PDFs will vary depending on the size of the file and your Internet connection speed To view the PDF format you must have Adobe Acrobat Reader If you do not have this program download it here for free at www adobe com Note User manuals are updated periodically and may not cover recently added features Please note the version date
41. ies 25 Example 2 Documentation Guide for SNP 4 Element C 2013 S amp P Measures The organization analyzes ts performance on managing care transitions 1 For all transitions conducting an analysis annually of its aggregate performance identifying that a planned transition is going to occur sharing the sending setting s care plan with the receiving setting within one business day of notification of planned and unplanned transitions and notifying the member s usual practitioner of planned and unplanned transitions within a specified timeframe 2 Drawing appropriate samples from the affected population for the transitions specified in factor 1 if a sample is used 3 For all transitions conducting an analysis annually of its aggregate performance communicating with the member or responsible party about the care transition process within a specified timeframe communicating with the member or responsible party about changes to the member s health status and plan of care within a specified timeframe and providing each member who experiences a transition with a consistent person or unit within the organization who is responsible for supporting the member through transitions between any points in the system within a specified timeframe 4 Drawing appropriate samples from the affected population for the transitions specified in factor 3 if asample is used 26 In 2012 Star Health Plan completed the implementation of tools
42. ist aspx TRUCTIONS LOGOUT Document Library Instructions SURVEY TOOLJOR Your document library has links to 0 document s in Survey Tool Select Standard s A Look For You can search by document extension part of or full document name or path For example docx MyPath MyDocument H Mypath Mydocument pdf Use this link to load pertinent documents to the document library If you need to see all documents within the library click on View All Note this will take some time if you have lots of documents Standard Element Document Name File Path Date Attached Stage Attached Reference Pages Relevance Add Link Unlink Unload Document Click here to view documents you have close this window already loaded to the document library 2002 2012 by National Committee for Quality Assurance Patent Pending Use ofthis Web sitefapplication constitutes acceptance of the License Agreement and Privacy Policy SNPS Institutional SNP Relationship With Facilitv 38 Screenshot 7C Document Library loading documents Add Document to Document Library Locate files to add to the Document Instructions Library by selecting Browse New Document Document Name Document File Path Use the Browse button to locate the document Document Name Document File Path Use the Browse button to locate the document Click here to upload Document Name the files you have selected to the
43. mit for Survey and save ereenshais TOA and 10B o ic on the Submit Survey Tool link on the Top Navigation Bar and b confirm that you are ready to submit your final Survey Tool This is the last chance you have to cancel the final submission of your Survey Tool c Click ok to submit your Survey Tool for survey Once submitted you will receive a confirmation and have access to a read only copy of your submitted Survey Tool Please note once you have successfully submitted you will receive a project number for that survey tool on the completed submission page Please save this number You will use it to verify you are viewing the correct final survey tool results once NCQA finalizes the scoring and notifies you of the results Alternatively if you receive an error message that indicates your organization applied for a different evaluation option than the one identified in the survey tool please check and make sure that you selected the appropriate evaluation option for a returning or new SNP Reviewing your results after NCQA completes the assessment After you receive notification from NCQA that the SNP Assessment is complete and your results are available log on to NCQA s ISS https iss ncga org RDSat ATLogin asp with your original User ID and password screenshot 114 If you cannot remember your password but still have your User ID click on the hypertext on the log in page that says If you have forgotten your Pa
44. n on selecting evaluation options click on the instructions link above the Structure amp Pr elements that sped specific scoring rul the data source nel the scope of revie additional explanatl To select evaluation options for readiness evaluation check the box for the product s in the Select for Readiness Evaluation column To select evaluation options to submit for survey check the box for the options in the Select to Submit for Survey column You may revise these selections at any time during your readiness evaluation This dynamic Survey Tool evaluate yourself just as documentation and make Select for P to begin the formal evalua Evaluation Option Survey Tool Re Select to Submit for Complete Eniastion Survey You may access a compl ae You may select any one of the following evaluation options Glossary are highlighted by clicking on the FA syl Returning ars SS E Hew SIPs Not Complete O 2002 Use of this Web siti Screenshot 10D Submit survey tool Submit Survey Tool SETUP MENU UNIT OF AS ENT EVALUATION OPTIONS JEY TOOL You will have to click on Submit Survey Tool again in Su Submitting the Survey Tool involves several steps including this pop up window Instructions verifying your Survey Tool settings against your application for survey ensuring you have uploaded all documents you intend to submit for survey e checking if your Survey Tool is complete We strongly encourage you
45. nts Ensure that your documents policies procedures reports and materials address all aspects of each factor and element The following is a list of documents recommended to attach as evidence of performance so the NCQA surveyor may complete the evaluation of your SNP plan against the Structure amp Process measures The list is not intended to be all inclusive or prescriptive Measure Documents SPECIAL NEEDS PLANS SNP 1 For Element A New Element a program description or policies and procedures that detail how the organization s care management program is structured These documents also identify the evidence it used to develop the program along with the services it provides and program goals For Element B New Element policies and procedures that detail how the SNP 1 assesses the characteristics of the population in the care management program 2 reviews and updates care management processes and 3 reviews and updates resources to address members needs For Element C Previously Element F policies and procedures and reports or materials are required These documents must show the organization has procedures and how it conducts an initial assessment of each member that enables it to obtain eight specific types of information that address each factor in the element For Element D Previously Element G policies and procedures reports or materials that detail how the SNP develops individualized care plans for member
46. nts for ol oiha caganizations are unatecied July 3 2013 A system update was made to NCQA s Interactive Survey System ISS on June 22 2013 which impacted the document library resulting in data corruption NCQA immediately disabled the document library once the issue was identified We have confirmed that the issue was isolated to the document library In order to resolve the data corruption the document library has been restored to the state prior to the system update As a result all document library additions or changes between 6 am ET on June 22 and 5 pm ET on June 25 have been lost if you made any document library changes within this period you will need to resubmit If you have forgotten your password please click here DO NOT use this link with License Number only under your survey tool name to access your results To see your FINAL RESULTS scroll down to Surveys amp Results and find your survey tool link under that header It will have a project 1D listed below it these changes Comments answers and scoring were not impacted by this issue If you have concems regarding your ability to meet your submission date due to this issue contact vaur ASC or Recoandion Proaram Manaoar Publications amp Licenses Your organization has licensed the following SNPA 2013 SNP A 2013 comp for CMonroe4 License 18443 2013 Special Needs Plans Structure amp Process Measures
47. ou can link unlink or edit documents 10 for any element Refer to the instructions under the Help tab for detailed information You can also add documents to the library without linking them to a specific element This feature allows you to load your documents so that they are available in a list of documents that you can access when you need to link a document to an element during your readiness evaluation NCQA limits the types of documents you may send see the list of recommended supporting documents at the end of these guidelines NCQA encourages you to submit only documents pages or sections necessary to demonstrate how your organization meets the requirements in the measures Preparing your documentation for submission in ISS requires you to follow several steps The Toolkit contains written instructions and screenshots to walk you through each process You must 1 load your documents to the Document Library and 2 link the documents to the appropriate element s For instructions on loading and linking documents please refer to pages 30 32 of the section titled Steps and Screenshots for Key Activities This document walks you through each activity and directs you to several screenshots which illustrate the steps you need to follow such as screenshots 7A 7C loading documents and 7D 7E linking documents In addition you may wish to view a demo within the ISS Tool on how to do this Select Help and Instructions on th
48. pending on whether you are a new or returning SNP close this window 2002 2012 by National Committee for Quality Assurance Patent Pending Use ofthis Web site application constitutes acceptance of the License Agreement and Privacy Policy 36 Screenshot 6A Enter survey tool SURVEY TOOL lick on Survey Tool jr Then click on the Special Needs Plans Survey Tool tab to enter the survey too To enter the Survey Tool select a tab above This section includes all the Structure amp Process measures that are used for evaluation The categories in the tabs above organize the Structure amp Process measures Each category includes information about the Structure amp Process measures necessary to understand the survey process This information includes the Structure amp Process measures elements that specify exactly how the Structure amp Process measures are evaluated and scored specific scoring rules for each element e the data source needed to document the scoring the scope of review for each element and additional explanation and examples This dynamic Survey Tool is used to evaluate organizations and individuals The Survey Tool allows you to evaluate yourself just as we will but at your own pace You may score yourself attach the necessary documentation and make comments Following your readiness evaluation you must submit the Survey Tool to begin the formal evaluation process You may
49. rganization meets the requirements within the measure Factor An item within an element that is scored For example an element may require the organization to demonstrate that a specific document addresses four items each item is a factor Data Source the types of documentation or evidence that the organization must use to demonstrate performance with an element NCQA defines four types of data sources however for the SNP S amp P measures assessment NCQA does not currently require records files 1 Documented process Policies and procedures process flow charts protocols and other mechanisms that describe an actual process used by the organization 2 Reports Aggregated sources of evidence of action or performance with an element including program evaluation management reports key indicator reports summary reports from member reviews system output giving information like number of member appeals minutes and other documentation of actions that the organization has taken 3 Materials Prepared materials or content that the organization provides to its members or practitioners including written and electronic communication information from Web sites scripts brochures newsletters and clinical guidelines 4 Records or Files Actual records or files that show direct evidence of action or performance with an element If multiple data sources are listed for an element the explanation section provides direction on what evidenc
50. rifying that that the documentation presented meets the intent of the requirements The organization s obligation is to present the documentation that demonstrates performance and to do so in a manner that facilitates review by the NCQA survey team The organization is expected to Provide the required documents Present them in an organized readable format Limit documentation to the minimum necessary to demonstrate performance Use available software features and tools such as highlighting and comments to direct the surveyors to evidence of performance If the surveyors do not find the specified evidence in the documents they will ask for clarification during Plan Comment and provide the organization an opportunity to respond The survey team does not summarily score an element less than 100 percent without notification to the organization of the issues When an organization provides numerous documents clear evidence of performance may not be obvious or apparent to the surveyor However the onus is on the organization to demonstrate its performance with each of the requirements 21 What is the Best Way to Prepare Documentation for the Survey Team It is important that organizations prepare documents in a manner for the survey team to review them efficiently NCQA requires that you do the following Reference the specific page number s and paragraph to which you want to draw the surveyor s attention D
51. rocedures describe eligibility criteria evaluation options the interactive survey process e the structure of the Standards and Guidelines and the Survey Tool Screenshot 11D View final results RESULTS 2013 Special Needs Plans Structure amp Process Measures Reports and numeric results generated or otherwise received from use of the Survey Tool are final once submitted to NCQA The organization may only use the reports and numeric results from the readiness evaluation for internal business Purposes to examine review and otherwise analyze its business operations and may not use disclose represent or otherwise communicate these reports or numeric results to any third party for any other purpose The organization may not represent that it is NCQA Accredited based on reports or numeric results No individual or entity may purchase a license to use the Survey Tool from NCQA or use it regardiess of the source to evaluate another organization against NCQA SNP structure and process measures This prohibition does not apply to individuals or entities that are assisting the organization with its readiness evaluation and preparation for an NCQA Survey The organization may not use the Survey Tool to evaluate another organization against NCQA SNP structure and process measures except as part of its own internal preparation for an NCQA Survey including specifically evaluating a delegate s performance in order to conduct oversight as required
52. rocess Readiness Evaluation Evaluation by NCQA NCQA s Web based Survey Tool for the Evaluation of a Special Needs Plan allows your organization to perform a readiness evaluation at its own pace before submitting data to NCQA You may assess your program s operations and evaluate your performance against the Structure amp Process Measures During the readiness evaluation stage NCQA does not view your information therefore you can use the tool to its full capacity and evaluate your organization in a variety of ways The NCQA survey process begins with the submission of the Survey Tool which is final upon receipt by NCQA All Survey Tools are due to NCQA no later than October 15 2013 If you have specific questions about your preparation contact Customer Service at 888 275 7585 8 30 a m 5 00 p m Eastern Time or via e mail at customersupport ncqa org Preparing for the Readiness Evaluation 1 To facilitate the process you may find it helpful to keep documents that you link to the Survey Tool in a single directory shared by all your users This will facilitate multiple users working on the Survey Tool You can modify move or rename a linked document since it is not final until you submit it to NCQA for the evaluation If you move or rename documents be sure to update the links in the Survey Tool before your final submission The Document Library includes a list of all documents loaded to your Survey Tool From here y
53. s that address the five required factors For Element E Previously Element reports containing an analysis of a care management satisfaction survey complaints and inquiries For Element F Previously Element J reports showing the analysis of three relevant measures to assess the effectiveness of the care management program For Element G Previously Element K reports showing interventions implemented and policies that describe plans for assessing intervention effectiveness and remeasurement SNP 2 For Elements A and B Reports demonstrating an evaluation of member complaint and appeal data including how the population was identified sampling methodology and collection of valid data 14 Reports showing an organizations analysis of CAHPS results and opportunities for improvement it identified if used Reports demonstrating identification of opportunities for improvement For Element C reports showing intervention implemented and the evaluation of the intervention effectiveness Organizations with no members at the start of the look back period may select not applicable N A however you must provide information to support the N A claim and NCQA will verify with the April 2013 CMS Comprehensive Report SNP 3 SNPs do not need to supply any documentation for this element NCQA staff will review HEDIS results submitted previously Organizations with less than 30 members per the February 2
54. ssword enter your User ID above and click here Your password will then be emailed to you Once on the main ISS home page please select the Survey and Results tab for each 31 survey tool which should have a project number listed directly below it screenshot 11B Open the survey tool s click the results tab agree to the statement regarding results and click on the red link for Special Needs Plans this will provide the score for each element BERET You should also go directly into the survey tool and view each element If your tool has elements with scores less than 100 click the Support Text Notes tab at the bottom of the element for an explanation of the score 32 Screenshot 1A Change password icon The ISS tool gives you the option to change your password Screenshot 1B Change password Interactive Survey System Publications and Survey Tools Your organization has licensed the following Web based publications In this section use the survey tools to complete your organization s self evaluation prior to submitting to NCQA Once the survey tool has been submitted you may view the information submitted to NCQA The survey tool will not contain the results of NCQA s evaluation To view the preliminary or final results of the NCQA survey scroll down to Survey amp Results Please select one to use 2012 SNP Survey Tool Web based 14 users License 32251 Administration
55. to print the Submission Instructions which describe the submission process in detail Survey Tool Setting and Survey Application Summary Your selections must match those for which you have applied for survey You may use the menu above to update your selections if applicable You have selected the following evaluation options Returning SNPs Not Completed E AD survey Supporting Documents Number of supporting documents referenced in the Document Library 0 Please note Your Survey Tool does not have all elements completed For most surveys all elements should be completed before submission Please contact your survey coordinator if you are unsure if you should complete all elements You can submit the Survey Tool with some elements incomplete but once submitted you will not be able to update or change any data To check view a list of incomplete elements for the evaluation option s you have selected click Completeness Check To return to the Survey Tool without submitting click on close this window 43 Screenshot 10E Submit survey tool Microsoft Internet Explorer x Click OK to confirm that the Survey Tool is final complete and ready to submit to NCQA for review Click Cancel to by return to the Submit screen without submitting the Survey Tool Then click Return to Survey Tool to exit the o a You will be prompted to confirm the submission Once submitted a survey tool cannot be changed
56. tor this is the person who was sent the tool originally can give three other individuals access to each of your survey tools e Do not push the Submit Survey Tool button unless your survey tool is complete and you are ready for NCQA surveyors to start the survey process e You must attach documentation to demonstrate performance for all factors and elements e When preparing for a survey please review the S amp P measures FAQs any policy Clarifications and training materials NCQA releases updating or clarifying the requirements FAQs and policy clarifications are effective upon release unless noted otherwise 2013 ISS Toolkit Reporting Requirements by SNP Type Element Measure SNP 1 Care Management and Coordination Element A Care Management Program Description Y Y Element B Population Assessment Y Y Element C Care Management Assessment Process Y Y Element D Individualized Care Plan Y Y Element E Satisfaction with Care Management N yu Element F Analyzing Effectiveness Identifying Opportunities N y Element G Implementing Interventions and Follow up Evaluation N yu Measure SNP 2 Improving Member Satisfaction Element A Assessment of Member Satisfaction y al Element B Opportunities for Improvement y y Element C Improving Satisfaction y Y Measure SNP 3 Clinical Quality Improvements Element A Clinical Improvements N Y Me
57. umented processes AND reports OR Materials Element C Documented processes AND reports OR materials Element D Documented processes AND reports OR materials Element E for each factor Documented processes AND reports If you would like examples of documented processes reports or materials please refer to the Data Sources Examples document or the Guidelines for a Successful Evaluation of a Special Needs Plan SNP Against the 2013 Structure amp Process Measures document SNPs must provide the required data sources to demonstrate performance specific to each factor For example for SNP 4 Element A factor 1 the SNP must provide documented processes AND reports materials For factor 2 the SNP must provide documented process AND reports materials This applies to each element in SNP 4 7 2013 ISS Toolkit Examples of Data Sources Documented Process A documented process includes policies and procedures process flow charts protocols and other mechanisms that describe the actual processes a SNP uses Reports Reports are aggregated sources of evidence of action or compliance with an element Materials Prepared materials or content the organization provides to its members and practitioners Policies and e Briefing materials e Evidence of Coverage procedures with e Checklists EOC timeframes where e Scripts e Management reports appropriate e Education materials e Key indicator reports Procedures for e Brochures e Reda
58. urvey Tool We will work with you to confirm your application and set a submission date for the Survey Tool and any documentation Your survey commences when you submit the Survey Tool at which point we consider any documentation attached to be final The Policies and Procedures provide complete details of the application and survey processes close this window Elements A B C D E E SNPS Institutional SNP Relatianshin With Facilitu Screenshot 5B Set up survey tool Select Evaluation Options ETUP MENU UNIT O Instructions To conduct a readiness evaluation and undergo survey you must select from the evaluation options below For additional information on selecting evaluation options click on the instructions link above To select evaluation options for readiness evaluation check the box for the product s in the Select for Readiness Evaluation column To select evaluation options to submit for survey check the box for the options in the Select to Submit for Survey column You may revise these selections at any time during your readiness evaluation Save Select for E Evslustion Option Survey Tool ende jelect to Submit for Complete Survey You may select any one of the following evaluation opti Returning SNPs Not Complete Y Mew SNPs Not Complete You should select the appropriate box under Sele for Readiness Evaluation de
59. vide information to support the N A claim and NCQA will verify with the April 2013 CMS Comprehensive Report Element F Policies and procedures for case managers or other staff to contact members at risk for a transition and arrange services SNP 5 Element A Policies and procedures that demonstrate how the SNP receives updates from facilities on members care and monitors their health Element B Procedures delineating how 1 the organization and facilities respond to changes in members health status and triggering events and 2 the member s care is coordinated with appropriate clinicians or care plan Elements A and B Contracts or agreements with facilities covering their reporting responsibilities Elements A and B Reports such as MDS or materials of how member health status data is collected Elements A and B Job descriptions of staff that visit members and reports they provide on changes in members health status Elements A and B Briefing materials distributed by facilities Element C Screenshots of the care management system showing monitoring assessments and care plan changes after a member s health status change along with discussions between nurse managers and treating practitioners regarding them Elements 5A 5B and 5C are not applicable N A for Institutional SNPs that do not have any contracts with nursing or assisted living facilities and for Chronic condition and Dual eligible benefit packag
60. view of the components of a measure and its elements with an emphasis on how to determine what documentation is needed Document Preparation This section describes how to prepare documents with suggestions on how to compile information highlight key sections in documents and direct surveyors to the specific information that demonstrates you meet an element lt also explains how NCQA will handle situations where it cannot find evidence of performance in the documentation either because it does not appear to be there or because the documents are not presented in a manner that makes it easy to find Documentation Guide This section provides an overview of what a documentation guide is and how it assists NCQA in the review of your documents lt also provides examples of how to compose a documentation guide 19 How the S amp P Measures are Structured In order to know what type of information and documentation to provide to the survey team it is important to understand how the measures are structured Each S amp P measure includes the following key information Standard Statement An actual statement that describes acceptable performance or results Intent Statement The statement that describes the importance purpose and meaning of the measure Element The component of a measure that is scored and provides details about performance expectations NCQA evaluates each element within a measure to determine the degree to which the o
61. y manage users via Administrative Functions or Change User Password screenshots 1A and 1B see full instructions in User Manual Select the ae survey tool by clicking on 2013 SNP S amp P link to enter the tool Click on the Help and Instructions tab for complete instructions or a Users Manual On Navigation Bar click Organization Background tab and complete screenshot 4A 10 You must set up your survey tool by selecting the appropriate SNP type before you can work in ISS Setting up your survey tool a Click Set up Survey Tool followed by Select Evaluation Options screenshot 5A c Select returning or new SNP d Select for Readiness Evaluation e click Save f close window to return to SNP page 11 Click Survey Tool to return to SNP page Top Navigation Bar includes ISS functions Blue Navigation Bar includes contents of the S amp P measures 12 Click the Special Needs Plans Tab then select the measure or element to begin readiness evaluation 13 You can load a document in ISS by going into the Document Library or directly from an element however the following instructions are for adding documents from the Document Library To load documents a click Document Library b click Load Document to the Library a form appears that contains fields you must complete entitled Document name and Document file path c use the Browse button to launch a file look in prompt of your local drives d locate the document

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