April 4, 2005
Tennessee Requires Medicaid Managed Care Plans to Earn NCQA Accreditation by End of 2006
TennCare is first in the nation to mandate Accreditation for Medicaid
WASHINGTON— Health plans participating in Tennessee’s Medicaid program, TennCare, must earn NCQA Accreditation by the end of 2006 under a new agreement between the state and NCQA. The new policy is aimed at improving the quality of care provided to the estimated 1.3 million Tennesseans enrolled in TennCare. TennCare is the first Medicaid program in the nation to adopt such a mandate.
“By requiring these plans to be NCQA Accredited, we can assure the people of Tennessee that our most vulnerable citizens are receiving the highest quality care,” said J.D. Hickey, Deputy Commissioner, Bureau of TennCare. “That’s our goal – to move forward in terms of quality, access, safety, confidentiality – all the things that matter to our beneficiaries. We’re looking forward to a productive relationship.”
Currently, eight health plans participate in TennCare: Better Health Plans, BlueCare, John Deere Health Plan, TLC Family Care Healthplan, OmniCare Health Plan, PHP TennCare, TennCare Select, and VHP Community Care
Tennessee joins the federal government and more than 30 other states that recognize NCQA Accreditation to satisfy federal or state requirements. TennCare is unique, however, in that it is the first and only Medicaid program to require all beneficiaries to enroll in managed care plans.
“Other state Medicaid programs should consider the same approach to quality oversight,” said NCQA President Margaret E. O’Kane. “By working together, we can drive improvement and reward excellence more effectively and efficiently than either of us could on our own.”
Since 1997, the federal government has allowed states to recognize private accrediting bodies like NCQA through a concept known as “deeming.” Organizations reviewed by such accreditors are “deemed” to have met some or all of the Medicaid standards. State Medicaid programs that have granted NCQA deeming authority include Colorado, Iowa, Maryland, Michigan, Minnesota, New Mexico, Ohio, Oregon, Virginia, Washington and Wisconsin.
"We're looking forward to earning NCQA Accreditation and demonstrating that we offer our Medicaid members high quality care and service said Bob Baker, M.D., Vice President for Medical Affairs for Better Health Plans, which serves more than 25,000 TennCare members. "This is good for Tennessee and it's good for Better Health Plans."
In order to assist plans in preparing for Accreditation, NCQA and the Bureau of TennCare will sponsor a series of training programs that will give plans detailed insights into the standards, data collection, program scoring and the online Interactive Survey System (ISS) that supports the accreditation process. The training programs are being underwritten by Pfizer Inc and NCQA.
NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. NCQA provides health care quality information free of charge through the Web and media in order to help consumers, employers and others make more informed health care choices.