February 6, 2006

Pennsylvania Incorporates NCQA Accreditation
into Medicaid Plan Oversight

Accreditation reports incorporated into regular monitoring,
improve review process for state, plans

WASHINGTON—Pennsylvania’s Medicaid program has joined a growing list of states that use health plan accreditation results from the National Committee for Quality Assurance (NCQA) to enhance and streamline plan oversight for portions of state and external quality review requirements. The state will use NCQA’s survey results for accredited Medicaid plans as part of its monitoring process, which will ultimately streamline oversight for the state’s seven Medicaid plans, all of which currently hold NCQA Accreditation.

NCQA Accreditation is a rigorous review consisting of both on- and off-site evaluations conducted by teams of physicians and managed care experts. A national oversight committee of physicians analyzes the team's findings and assigns an accreditation level based on the plan's compliance with NCQA standards and its performance relative to other plans on select performance measures such as immunization rates, mammography rates, and member satisfaction. Pennsylvania’s Office of Medical Assistance Programs will take the results of NCQA Accreditation surveys into account as part of its monitoring of the state’s Medicaid plans.

Currently, 32 states and the federal government recognize NCQA Accreditation to satisfy regulatory requirements in part or in whole “Health plans holding NCQA Accreditation have demonstrated a commitment to providing their members the best care and the highest level of service,” said Richard Sorian, NCQA Vice President for Public Policy. “We’re pleased that Pennsylvania will use NCQA Accreditation results in its Medicaid oversight efforts, and we encourage other states to do the same.”

“NCQA’s evaluations have made important contributions to quality improvement and increased accountability among Pennsylvania’s Medicaid managed care plans,” said David Kelley, M.D., Chief Medical Officer of the Office of Medical Assistance Programs. “We look forward to the survey results becoming an even more integrated part of the oversight process.”

For further information about federal or state recognition of NCQA Accreditation, contact Kristine Thurston Toppe, Director of Public Policy, at (608) 210-6645.

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.