August 16, 2005

Virginia, DC Medicaid Programs Expand Use of NCQA’s Tools For Public Reporting, Quality Improvement

Virginia Medicaid requires NCQA Accreditation,
District of Columbia implements HEDIS performance measures

WASHINGTON—Virginia and the District of Columbia have joined a growing list of states that require health plans participating in Medicaid to adopt NCQA standards and measures as an integral part of their quality oversight efforts. Under a new agreement between the Commonwealth and participating plans, all Virginia Medicaid managed care plans must hold NCQA Accreditation or come forward for review by the end of 2005. Additionally, the District of Columbia Department of Health will require its Medicaid plans to report 41 HEDIS measures, including those that assess cancer, diabetes, and asthma care. These announcements reflect the growing emphasis among state Medicaid programs on measuring and improving clinical quality.

As of July 1, 2005, the Virginia Department of Medical Assistance Services has required all eight of its Medicaid managed care plans to come forward for an NCQA Accreditation review by the end of the year. Currently, six Virginia Medicaid plans hold NCQA Accreditation. Virginia joins the federal government and more than 30 other states in recognizing NCQA Accreditation to satisfy federal or state requirements. Virginia is also the second state, after Tennessee, to require all Medicaid managed care plans to come forward for NCQA Accreditation.

The District of Columbia Department of Health recently amended its contracts with Medicaid managed care organizations to include HEDIS performance measure reporting, becoming the 30th state to mandate HEDIS reporting by health plans. This decision affects D.C.’s approximately 142,000 Medicaid beneficiaries and three major Medicaid plans. HEDIS performance measures are designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans.

“This is a huge step towards expanding our quality improvement efforts by measuring performance on a richer set of standards,” said Gregg A. Pane, M.D., Director, D.C. Department of Health. “We believe this ultimately leads to improved care for all Medicaid beneficiaries in the District.”

“We welcome the actions that the Commonwealth of Virginia and the District of Columbia have taken to make their oversight and quality improvement efforts more rigorous and efficient,” said Richard Sorian , NCQA Vice President, Public Policy.  “By working together with these states and others who recognize the value of NCQA Accreditation and HEDIS reporting, we will drive excellence more effectively than we could on our own.”

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS, the tool the nation’s health plans use to measure and report on their performance. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices.