NCQA MEDICARE ADVANTAGE DEEMING AUTHORITY
RENEWED BY THE CENTERS FOR MEDICARE & MEDICAID SERVICES
More than 70 health plans currently benefit from more efficient surveys
WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) has renewed the authority of the National Committee for Quality Assurance (NCQA) to conduct surveys of Medicare Advantage (MA) plans under Medicare’s deeming authority. The six-year renewal runs through January 14, 2014, and allows NCQA-accredited managed care organizations (MCOs) to receive credit for meeting Medicare requirements in six key areas of review.
Deeming allows accreditation or certification from an independent review organization to serve in place of reviews by public entities such as CMS. Plans that have earned MCO Accreditation from NCQA—widely regarded as the most demanding accreditation program in the industry— are considered to be in compliance with CMS regulations in the following areas of care and service:
- Access and Availability of Services
- Advance Directives
- Antidiscrimination
- Confidentiality and Accuracy of Enrollee Records
- Provider Participation Rules
- Quality Assurance
“We are thrilled to receive this confirmation of the quality of our review process,” said NCQA President Margaret E. O’Kane. “Deeming allows for a more efficient approach to health plan oversight, allowing plans to focus more of their resources on improving the care of their members.”
NCQA was originally approved by CMS for deeming in 2002, becoming the first health plan accrediting organization to be so recognized. Today, more than 70 Medicare Advantage plans take advantage of this authority to streamline their reviews. In 2004, CMS also approved NCQA for review of preferred provider organizations (PPOs) participating in Medicare Advantage.
“Geisinger Health Plan’s Accreditation standing with NCQA is a point of pride,” said Richard J. Gilfillan, M.D., President and Chief Executive Officer, Geisinger Health Plan. “We’re pleased that CMS recognizes the high standards that are represented by the NCQA Accreditation seal. Their renewal of NCQA’s deeming authority helps us focus our efforts on what we do best – ensuring that our members receive top-notch care.”
For more information on NCQA’s deeming program, visit www.ncqa.org/publicpolicy.aspx or contact Alix Love, Manager of Public Policy at love@ncqa.org. NCQA’s MA Modules are available in printed or electronic formats; for more information, visit www.ncqa.org/publications or call NCQA 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 recognizes physicians in key clinical areas. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely used performance measurement tool in health care. 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. For more information, visit http://www.ncqa.org/.
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