New accreditation standards take effect Jan. 1, 2014

NCQA and Joint Commission standards relevant to psychologists further the shift toward integrated care.

Two sets of standards are set to take effect Jan. 1, 2014, that are relevant to psychologists who work in accredited health plans or health homes: the National Committee for Quality Assurance’s (NCQA) Updated Wellness and Managed Behavioral Healthcare Organization standards and the Joint Commission Behavioral Health Home standards. 

NCQA is a private, not-for-profit organization that offers accreditation, certification and recognition programs dedicated to improving the quality of health care in the U.S. NCQA accredits and certifies a wide range of health care organizations such as managed care plans, managed behavioral health care organizations and preferred provider organizations, and manages a performance measurement tool used by more than 90 percent of the nation’s health plans. NCQA accreditation is intended to help health plans demonstrate a commitment to quality and accountability and to help consumers, employers and others make more informed health care choices. 

NCQA’s Managed Behavioral Healthcare Organization (MBHO) Accreditation was updated for 2014 to focus on the growing emphasis in health care reform on integrated, whole-person care. These updates were developed by a panel of previously accredited MBHOs, health plans, state agencies, consumer organizations and behavioral health care researchers. The APA Practice Directorate’s Office of Legal & Regulatory Affairs submitted comments in March 2013 during the revision process. 

APA supported the general goals of many proposed updates, such as: providing employers, public purchasers, health plans and consumers with meaningful information about MBHOs; strengthening MBHO systems for quality improvement programs; and addressing the need for prevention, early intervention and coordination of behavioral health care with medical care. APA offered suggestions for clarification and/or revision of sections related to assessment of behavioral health paraprofessionals, practitioner and provider directories, utilization management structure and self-management tools. 

As reflected on the NCQA website, MHBO accreditation emphasizes: 

  • Care coordination to reduce fragmented care, especially for people with special needs.
  • Complex case management to manage the increasingly complex needs of patients receiving both medical care and behavioral healthcare — a challenge for managed care initiatives where complex cases are common.
  • Data exchange between health plans and behavioral healthcare organizations. This supports clinical quality and patient experience measurement and improvement by the MBHO.

Joint Commission Behavioral Health Home standards

The Joint Commission evaluates and accredits more than 20,000 health care and programs in the United States. In August, the Joint Commission released new standards that will be effective Jan. 1, 2014, for behavioral health care organizations wishing to pursue Behavioral Health Home (BHH) Certification. BHH Certification recognizes organizations that act as a health home by integrating and coordinating physical and behavioral care for the individuals they serve. 

APA has been represented on the Joint Commission’s Behavioral Health Care Professional and Technical Advisory Committee (PTAC) by Steven D. Moore, PhD, since 2010. As part of the PTAC, Moore reviews draft recommendations proposed by Joint Commission staff (who have reviewed current health care trends and relevant legislation) to determine if there are any implications — positive or negative — for professional psychology and provide input as needed. 

The new Behavioral Health Home standards are intended to further promote the integration of behavioral and physical health within health homes. Though most private practices will not meet the standards to qualify as a health home, which requires large-scale integration and the ability to coordinate care across all aspects of health care for a given patient, psychologists are recognized as providers within the health home model. 

“These standards reflect changes that are being required by the Affordable Care Act and similar reforms in individual states,” says Moore.  “It’s all part of the move toward integrated care and improving health outcomes.  And the implications for psychologists are that collaboration with other disciplines will become more and more important over time.”