TENNESSEE RECOGNIZES NCQA ACCREDITATION AS MEETING STATE UTILIZATION MANAGEMENT REQUIREMENTS
Plans Holding NCQA Accreditation Considered to Meet Tennessee Criteria, Exempted From Duplicative Review
WASHINGTON—NCQA-Accredited health plans in Tennessee are now considered to meet the state’s regulatory requirements for utilization management and are exempt from further state review of the relevant requirements. A new law signed by Governor Phil Bredesen reduces the regulatory burden on these plans by eliminating duplicative review. Currently, nine commercial and Medicare plans in Tennessee hold Accreditation from NCQA.
“NCQA’s Accreditation program requirements set a high bar. By incorporating them into our utilization management oversight efforts, we can more efficiently focus our regulatory resources upon areas that need more attention,” said Dave Goetz, Commissioner, Tennessee Department of Finance & Administration. “It’s a benefit to all Tennesseeans enrolled in a health plan.”
Currently, 38 states and the Federal government recognize or require NCQA Accreditation as meeting their requirements for managed care plans (see below). States recognizing standards can use information obtained from an NCQA accreditation survey to streamline health plan monitoring and oversight. In addition to the new law signed by Governor Bredesen, Tennessee also requires managed care organizations participating in the state’s TennCare Medicaid program to be NCQA Accredited.
“We welcome the steps that the State of Tennessee has taken to streamline their oversight and quality improvement efforts,” said Richard Sorian, NCQA Vice President, Public Policy. “NCQA Accredited health plans are among the best in the nation. Working together with those states and other interested parties who recognize the value of NCQA Accreditation, we will drive excellence more effectively than either of us could alone.”
For more information about how states can use NCQA information to supplement their managed care oversight efforts, contact Alix Love, Acting Director, Public Policy, at (202) 955-1720 or love@ncqa.org.
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.
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38 States Use or Recognize NCQA Accreditation
Commercial
1. Arizona
2. California
3. Colorado
4. Delaware
5. Florida
6. Georgia
7. Hawaii
8. Illinois
9. Indiana
10. Iowa
11. Kansas
12. Kentucky
13. Maine
14. Maryland
15. Massachusetts
16. Michigan
17. Minnesota
18. Missouri
19. Montana
20. Nebraska
21. Nevada
22. New Hampshire
23. New Jersey
24. New Mexico
25. Ohio
26. Oklahoma
27. Pennsylvania*
28. Rhode Island
29. South Carolina
30. Texas
31. Utah
32. Vermont
33. Virginia
34. Washington
35. West Virginia*
*NCQA Review or Accreditation Required
Medicaid
1. Arizona
2. California
3. District of Columbia*
4. Florida
5. Georgia
6. Iowa
7. Kentucky*
8. Maryland
9. Massachusetts
10. Michigan*
11. Minnesota
12. New Mexico*
13. Oregon
14. Pennsylvania
15. Rhode Island*
16. South Carolina
17. Tennessee*
18. Texas
19. Utah
20. Virginia*
21. Washington