January 9, 2004

CMS APPROVES NCQA’s 2004 MEDICARE+CHOICE DEEMING STANDARDS

Announcement follows successful second year of program; more than a third of all M+C plans now participate in NCQA’s M+C deeming program

WASHINGTON—NCQA today announced that the Centers for Medicare and Medicaid Services (CMS) has approved NCQA’s 2004 Managed Care Organization (MCO) standards as meeting or exceeding Medicare’s quality requirements. As a result, private managed care organizations participating in Medicare+Choice will be able to apply their NCQA Accreditation towards satisfying certain federal regulatory requirements, thus streamlining the oversight process.

In 2002, NCQA became the first private accreditation organization to gain deeming authority under Medicare+Choice. Since that time, NCQA has become the industry leader in granting M+C plans deemed status. Currently 53 of the approximately 150 plans participating in the M+C program have opted to pursue NCQAM+C deeming. 

“We’re enormously pleased by CMS’s continued support for our standards. Deeming provides CMS with the assurance that health plans are providing quality services and streamlines regulatory oversight for accredited plans,” said Kathleen Mudd, NCQA Vice President for Product Delivery. “Under the recently enacted Medicare law we believe more private plans – including MCOs and PPOs – will participate in Medicare and we look forward to serving their needs.”

NCQA’s M+C deeming program build off the organization’s existing managed care organization accreditation program, which meets about 80% of the standards CMS requires.  An additional M+C module includes 12 additional Medicare-specific requirements. CMS found that NCQA’s standards “met or exceeded” the requirements of the Medicare+Choice program in six areas:

• Quality assurance
• Information on advance directives
• Anti-discrimination
• Access to services
• Provider participation rules
• Confidentiality and accuracy of enrollee records  

While there were few notable changes to the latest version of NCQA’s M+C standards, NCQA is moving the M+C program from a paper-based process to a web-based platform. This on-line version is much more efficient and interactive and will allow participating organizations to get preliminary feedback on their performance before surveyors ever arrive on site.  NCQA’s Interactive Survey System has been in use successfully for other NCQA programs for nearly two years.  

“NCQA’s deemed status with CMS saves our company time, effort and money,” said Richard Snyder, M.D., Vice President Quality Management, Independence Blue Cross. “And year after year earning NCQA Accreditation is a constructive learning experience that helps us facilitate the best possible care and service to our members.”

NCQA’s 2004 M+C module will be available for purchase in March.  Interested parties may purchase the standards online at www.ncqa.org.  Organizations interested in undergoing a survey should call Customer Support at (888) 275-7585.

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.  Along with its partners, NCQA also offers recognition programs for individual physicians and physician groups.  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.

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