Working with States

States Recognizing NCQA Accreditation

29 states with Medicaid managed care require or recognize NCQA Health Plan Accreditation. 5 additional states leverage NCQA Health Plan Accreditation results to support plan oversight and federal regulatory requirements.

 

Map of States (Updated April 2018)

List and Sources (Updated April 2018)

Fact Sheet – How States Can Maximize Use of Accreditation Results! (NEW!)

Fact Sheet – NCQA LTSS Distinction (NEW!)

 

33 states in the commercial market – including Departments of Insurance and Public Employee Benefit Programs - require or recognize NCQA Health Plan Accreditation.

 

Map of States (Updated April 2018)

List and Sources (Updated April 2018)

States Recognizing NCQA PCMH

27 Public Sector medical home initiatives across 23 states require or use NCQA PCMH Recognition

 

 

Map of States (Updated April 2018)

Fact Sheet – NCQA PCMH in Action (NEW!)

States Recognizing HEDIS

41 states collect or require HEDIS/CAHPS.

 

 

 

Map of States

List and Sources (Medicaid)

List and Sources (Commercial)

 Resource for State Agencies

NCQA’s Public Policy Department partners with state agencies to identify opportunities to align the state’s quality strategy and operational standards with NCQA’s requirements for performance improvement and measurement.   The Public Policy Department is available as a resource to state agencies with questions about NCQA’s programs or that wish to learn more about the process of using accreditation for streamlined oversight. 

Please contact Kristine Thurston Toppe.

2017 Medicaid Managed Care Toolkit

The 12th annual release of NCQA's Medicaid Managed Care Toolkit provides states and their contracted quality partners with a guide to making the most of accreditation and the HEDIS and CAHPS reporting NCQA requires of plans we accredit.

The toolkit explains how states can take advantage of the federal authority to streamline oversight of Medicaid managed care plans through the use of private accreditation for health plans. Using accreditation for oversight reduces unnecessary duplication in the oversight process. The toolkit highlights the areas where NCQA’s evaluation standards and performance measures can be used to supplement and, when considered applicable, serve in lieu of relevant Medicaid requirements and complement the mandatory EQRO activities.

2017 Medicaid Managed Care Toolkit Summary

For the complete Toolkit, please contact Kristine Thurston Toppe.