Working with States

States Recognizing NCQA Accreditation

Currently, 41 states recognize NCQA Health Plan Accreditation in whole or part in either their commercial market and/or their Medicaid managed care program.

 

 

Map of States using NCQA Accreditation in commercial or Medicaid managed care oversight

States Using NCQA Commercial managed care accreditation and certification programs

States Using NCQA Medicaid managed care accreditation or certification programs

 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.

2016 Medicaid Managed Care Toolkit

The 11th 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.

2016 Medicaid Managed Care Toolkit Summary

For the complete Toolkit, please contact Kristine Thurston Toppe.