Clinical Policy Web Posting Form

Page 1 of 4 Clinical Policy Web Posting
Reference Number: CP.CPC.02 Date of Last Revision: 08/25

Revision Log

Description
This policy details corporate and health plan responsibilities for initial posting and maintenance of clinical and payment on the public health plan websites.

I. Work Process - Plan Managed Posting (Process applicable prior to the Clinical Policy team approaching the plan about the posting partnership as described below in II. / if plan declines posting assistance) A. Initial set up

1. Corporate responsibilities for initial set up of clinical policy folders include: a. Communicating with corporate and health plan marketing departments to ensure proper set up of web pages and appropriate access to Adobe Experience Manager (AEM) is granted; b. Loading all 508-compliant corporate clinical policies into the corporate SharePoint and AEM folder; c. Communicating with plan-level designee regarding status of project.
2. Health plan responsibilities for initial set up of clinical policy page include: a. Identifying a designee who will be the main point of contact and perform all work related to posting and maintaining clinical policies; b. Communicating with the health plan marketing or compliance department to determine applicable state regulations, such as web page or specific policy approval requirements; c. Determining which policies are appropriate to post, considering state regulations/contractual requirements at a minimum; d. Identifying plan-level approvers, if needed; e. Uploading appropriate 508-compliant corporate and plan-specific policies into SharePoint and AEM to the specified plan folder; f. Linking appropriate policies to the health plan website; g. Notifying providers that clinical policies are available and providing training on how to find them, as needed.
   B. Ongoing maintenance
3. Maintenance of clinical policies a. The corporate clinical policy team and Clinical Policy Committee will review and approve all corporate clinical policies on an annual basis and upon significant change to evidence-based guidelines. The corporate clinical policy team will post the updated policies in the corporate clinical policy folder in SharePoint and AEM. b. Email updates will be sent to the health plan designees on the following basis: i. Notification when a policy is being retired, including a list of any policies that will replace the retired policy; ii. Monthly updates (or a cadence specific to central Quality Improvement / Utilization Management committee approvals, as applicable), including policy revisions and new policies.

CLINICAL POLICY

Clinical Policy Web Posting Page 2 of 4 c. The health plan Medical Director, or designee, and applicable Quality Improvement or Utilization Management Committee, will review and approve all clinical policies on an annual basis and upon significant change in evidence-based guidelines. The health plan is responsible for notifying the clinical policy designee in a timely manner of any changes, new policies, and retired policies.
d. Based on policy updates, the health plan designee will make updates to the health plan’s clinical policy web posting folder in AEM as necessary.

2. Quarterly review of posted clinical policies a. The health plan designee should review the health plan’s clinical policy web posting folder on at least a quarterly basis to ensure:
   i. All policies are current; ii. All policies are still appropriate to be posted on the public website; iii. Any appropriate new policies are added; iv. Any retired policies are made non-searchable.
3. Ensuring compliance a. The corporate clinical policy team will ensure corporate clinical policies follow evidence-based guidelines and compliance with NCQA (National Committee for Quality Assurance) regulations. b. The health plan will ensure compliance with local regulations related to clinical policies, posting of policies on the public website, and communicating with providers.

4. Notifying providers a. It is the responsibility of the health plan to communicate with providers when clinical policies are made available on the public website, as required. b. The health plan will provide ongoing support and communication to providers regarding clinical policy changes via the public website.

   II. Work Process – Corporate Clinical Policy Team Posting Partnership A. Initial set up

5. Corporate responsibilities for initial set up of clinical policy folders include: a. Communicating with health plan marketing departments to ensure proper set up of web pages and appropriate access to Adobe Experience Manager (AEM) is granted; b. Receiving and updating the current versions of corporate and state specific policies to the plan specific folders on SharePoint and in AEM as follows: i. Listing the corporate policy and revision date in the plan active policy list in the plan specific SP folder; ii. Uploading the 508-compliant plan-specific policies to the plan specific SP folder; iii. Uploading 508-compliant corporate and plan-specific policies to the plan specific AEM folder; c. Requesting linking to policies in AEM by marketing or linking appropriate policies to the health plan website;
6. Health plan responsibilities for initial set up of clinical policy page include: a. Identifying a designee who will be the main point of contact and perform all work related to selection and approval of clinical policies;

CLINICAL POLICY

Clinical Policy Web Posting Page 3 of 4 b. Communicating with the health plan compliance department to determine applicable state regulations and specific policy approval requirements; c. Determining which policies are appropriate to post considering state regulations/contractual requirements at a minimum; d. Identifying plan-level approvers, if needed; e. Requesting the posting of the appropriately approved policies by the corporate clinical policy team for uploading to the health plan specific folders in SharePoint and/or AEM (Clinical Policy Posting Request); f. Notifying providers that clinical policies are available and providing training on how to find them, as needed.
B. Ongoing maintenance

1. Maintenance of clinical policies a. The corporate clinical policy team and Clinical Policy Committee will review and approve all corporate clinical policies on an annual basis and upon significant change to evidence-based guidelines. The corporate clinical policy team will post the updated policies in the corporate clinical policy folder in SharePoint and AEM. b. Email updates will be sent to the health plan designees on the following basis: i. Notification when a policy is being retired, including a list of any policies that will replace the retired policy; ii. Monthly updates (or a cadence specific to central Quality Improvement / Utilization Management committee approvals, as applicable) including policy revisions and new policies.
   c. The health plan Medical Director, or designee, and applicable Quality Improvement or Utilization Management Committee will review and approve all clinical policies after receipt of policy updates from the clinical policy team on an annual basis and upon significant change in evidence-based guidelines. The health plan is responsible for notifying the clinical policy designee in a timely manner of any changes, new policies, and retired policies.
   d. Based on policy updates, the health plan designee communicates plan-approved updates to the corporate clinical policy team for AEM and website updates (Clinical Policy Posting Request).
2. Quarterly review of posted clinical policies a. The health plan designee should review the clinical policy web posting folder on at least a quarterly basis to ensure: i. All policies are current; ii. All policies are still appropriate to be posted on the public website; iii. Any appropriate new policies are added; iv. Any retired policies are made non-searchable.
3. Ensuring compliance a. The corporate clinical policy team will ensure corporate clinical policies follow evidence-based guidelines and compliance with NCQA (National Committee for Quality Assurance) regulations. b. The health plan will ensure compliance with local regulations related to clinical policies, posting of policies on the public website, and communicating with providers.

CLINICAL POLICY

Clinical Policy Web Posting Page 4 of 4

4. Notifying providers a. It is the responsibility of the health plan to communicate with providers when clinical policies are made available on the public website, except for legacy WellCare Medicare plans, for which the Clinical Policy team coordinates provider notification. b. The health plan will provide ongoing support and communication to providers regarding clinical policy changes via the public website.

   Reviews, Revisions, and Approvals Date Approval Date Policy developed 11/16 12/16 Annual review. 11/19 11/19 Annual review. Removed CC.COMP.22.01 Creating and Maintaining and P&Ps and replaced it with CC.COMP.22 Policy Management 11/20 11/20 Annual review. References reviewed and verified. Changed “review date,” in the header to, “date of last revision,” and, “date,” in the revision log header to, “revision date." 11/21 11/21 Annual review. Added work process for health plans partnered with corporate clinical policy team for posting. 11/22 11/22 Annual review. Reformatted policy and added clarifying criteria to header above section I. In the initial setup section of I. and II: changed order of steps related to communicating with compliance regarding state regulations, etc. and determining which policies are appropriate to post; added to the step regarding determination of appropriate policies to post that this should consider state regulations and contractual requirements at a minimum. In the ongoing maintenance section in I and II: added that the update emails from the CP team could be sent on a cadence specific to an applicable central QI/UM committee; noted that the plan MD or designee is responsible for policy review, and added the QI committee as an option for approval. Clarified in II.4.a. that for legacy WellCare Medicare plans, provider notification is coordinated by the Clinical Policy team. 10/23 10/23 Annual review. Verbiage updated throughout policy with no impact on criteria. Updated II.A.1.b. to reflect posting instructions for SP and AEM as well as addition of active policy list.
   08/24 08/24 Annual review. References reviewed.
   08/25 08/25

   References

5. CC.COMP.22 Policy Management
6. CC.MRKT.02 Health Plan Websites