Explaining HPA 2022: Utilization Management (UM)-OnDemand
Explaining HPA 2022: Utilization Management (UM)-OnDemand
This OnDemand course is a thorough examination of the Health Plan Accreditation standards for Utilization Management (UM). Faculty will give participants guidance for interpreting the requirements, navigating the standards and avoiding misconceptions, and will facilitate brief activities that simulate addressing requirements. This course is appropriate for all professionals with a direct or indirect stake in NCQA Accreditation.
This course presents information based on Health Plan Accreditation 2022 standard requirements and its contents apply directly to NCQA Accreditation Surveys conducted between July 1, 2022, and June 30, 2023.
- For content pertaining to Delegation requirements, use “Delegation” to search NCQA courses at www.ncqa.org/education-training/
- For content dedicated to the policies and procedures for Health Plan Accreditation (HPA), please consider taking the course Fundamentals of Health Plan Accreditation (HPA)
To inquire about group training rates, complete our online form.
- Controlling UM systems.
- Handling member appeals.
- Determining coverage and medical necessity.
- Administering denial notices.
- Improving survey readiness and performance
Benefits and Resources
- Presentation slides.
- Recording of live session.
- Live Q&A.
- Scenarios for applied learning.
- NCQA surveyor’s perspective of the standards.
- ACCME Credits for clinicians.
- Clinicians, directors, managers, specialists and coordinators.
- Consultants, contractors, delegates and vendors.
- Health plans and managed care organizations.
- Professionals in compliance, risk management or public policy.
- Professionals in population health or public health.
- Professionals in quality assurance/improvement or performance management.
- Explain the intent of the HPA UM standards.
- Define performance issues and target results within the scope of requirements.
- Describe relationships and themes across the UM elements.
- Discuss requirement implications and considerations for stakeholders.
- Critique examples and scenarios to enhance application.
Clint Koenig, MD, MSPH, MA
Clint Koenig, MD, MA, MSPH is the senior Medical Director at Ohio Healthy, a new system-based health plan in Columbus Ohio. He has served as State Medical Director in New Hampshire and Ohio. Other leadership roles include the Health Plan Regional Chief Medical Officer at Universal American, a government programs health management organization in Syracuse New York as well as the Director for Utilization Management at Monroe Plan for Medical Care, a healthcare management organization in Rochester, New York. In addition, Clint held Chief Medical Officer roles in Federally Qualified Health Centers and integrated delivery systems.
He has been an NCQA surveyor for 10 years and surveys health plans, Patient Centered Medical Home, Special Needs Plans and Long Term Services and Supports organizations.
Dr. Koenig received his MD from Albany Medical College in Albany, NY. He completed his residency in Family Medicine, from the University of Missouri. He also completed a fellowship at the University of Missouri, where he received Masters degrees in Public Health and Journalism.
In support of improving patient care, the National Committee for Quality Assurance is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), the American Nurses Credentialing Center (ANCC), the American Academy of Physician Assistants (AAPA), the American Psychological Association (APA), and the Association of Social Work Boards (ASWB) to provide Interprofessional Continuing Education for the healthcare team.
This activity was planned by and for the healthcare team, and learners will receive 2.5 Interprofessional Continuing Education (IPCE) credit for learning and change.
This educational activity is approved for: 2.5 AMA PRA Category 1 CreditTM.
This educational activity is approved for 2.5 nursing contact hours.*
This live course grants 2.0 Continuing Education Unit (CEU) points for PCMH Certified Content Experts. This course is not considered a required CCE quarterly webinar.
The assigned universal program number(s): JA0004597-0000-21-024-H04-P upon successful
completion of this program (attending the full session and completing a program evaluation),
participants will access CPE Monitor on the ACPE website to locate and track their CPE statement
* Please note – You must attend the entire program to be eligible for total number of contact hours.
"ATTENTION: Effective February 1, 2022, this on-demand (enduring material) activity no longer offers credits for the American Academy of Physician Assistants (AAPA), the American Psychological Association (APA), or the Association of Social Work Boards (ASWB). Only applicable professionals who fully completed this on-demand activity prior to February 1, 2022, are eligible for AAPA, APA, or ASWB credits. No other CEUs are impacted by this change.”
Disclosure of Relevant Financial Relationships
The National Committee for Quality Assurance (NCQA) endorses the Standards of the Accreditation Council for Continuing Medical Education which specify that sponsors of continuing medical education activities and presenters at and planners for these activities disclose any relevant financial relationships either party might have with commercial companies whose products or services are discussed in educational presentations.
For sponsors, relevant financial relationships include large research grants, institutional agreements for joint initiatives, substantial gifts, or other relationships that benefit the institution. For presenters or planning committee members, relevant financial relationships include the receipt of research grants from a commercial company, consultancies, honoraria, travel, or other benefits, or having a self-managed equity interest in a company; or having an immediate family member or partner with such a relationship.
Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.
Relevant financial relationships exist with the following companies/organizations:
Clint Koenig: None
Additional Planning Committee Members:
Vincent Pereira: None
Shelly Smith: None
This program was developed in part by NCQA staff.
This program received no commercial support.
- 2.50 ACPE
- 2.50 AMA PRA Category 1 Credit™
- 2.50 ANCC
- 2.50 IPCE
- 1.00 Participation
- 2.00 PCMH CCE