In 2006, NCQA created its first Medicaid Managed Care Toolkit in consultation with the Centers for Medicaid and State Operations, in response to numerous inquiries from state Medicaid programs. Updated to reflect the 2008 Health Plan Accreditation Standards, this guide outlines how states can streamline oversight of Medicaid managed care plans and reduce unnecessary duplication in oversight through the use of private accreditation.
The toolkit highlights the areas where NCQA’s evaluation standards can be used to supplement and, when considered applicable, serve in lieu of relevant Medicaid requirements. The summary (available to download) provides an overview of how NCQA standards and HEDIS measures can be used to complement the mandatory EQRO activities. The crosswalk compares the Federal Medicaid managed care regulations to NCQA standards.