State Briefing: Making the Most of Accreditation

October 16, 2020 · Amy Maciejowski

State regulators have huge responsibilities but limited resources to meet them. That is why so many rely on NCQA Health Plan Accreditation to further their quality goals. This month NCQA hosted a briefing to help states understand how to maximize these benefits.

Representatives from MASSHEALTH Quality Office joined our webinar to discuss the benefits of accreditation and how they use NCQA’s accreditation standards and the HEDIS Audit to streamline their own review of Medicaid plans in their state.

Accreditation Review Saves Time, Effort and Money for Massachusetts

Massachusetts, along with an additional 26 states, require their Medicaid plans to obtain NCQA Health Plan Accreditation. They take their use of accreditation one step further by including a detailed use of Accreditation in their Quality Strategy and use the Accreditation results and the HEDIS Audit to satisfy mandatory federal requirements set forth by the Medicaid Managed Care Rule.

Jillian Richard, Deputy Director of MASSHEALTH Quality Office, explained how Massachusetts uses NCQA Health Plan Accreditation review to “pass those areas of the compliance audit and lighten the load for plans in terms of administrative burden and submission of documentation.” Richard described how the review alleviates some of that burden for plans, especially if they are reviewed for several Medicaid product lines.

Focusing specifically on how the state uses the HEDIS Compliance Audit results, “because they undergo the audit they do not have to go through as detailed of a process with the state’s EQR vendor,” said Richard.

“That audit report serves as the basis for code review, all the stuff the EQR vendor would have to do has already been done which saves a lot of time and effort and money on our end for the state Medicaid program.” 

Leveraging accreditation results is one of the many benefits of Accreditation.

NCQA recommends three ways to make the most of Accreditation in your state:

Maximize scope of your state’s mandate

States can further maximize  HPA benefits with these sister standards that let states customize the review for Medicaid plans:

  1. Long-Term Services and Supports Distinction.This Distinction module provides oversight for plans that provide LTSS services.
  2. Multicultural Health Care Distinction. This Distinction module examines whether plans are following CLAS standards.
  3. MED Module.This module expands the federal Medicaid deemable standards NCQA can review a plan for during an accreditation survey.

We evolve our accreditation programs and always look to new avenues that would benefit states such as addressing health equity, disparities, and telehealth.

Harness Critical Features

NCQA continuously enhances the basic Accreditation review, making it the most rigorous program in the country. For example, we included a Population Health Management category within the accreditation review, which sets a standard for evaluating the health of a plan’s population. States use the population health management standards to guide plans and operationalize goals for achieving state health priorities.

Look for savings in areas of duplication to better manage administrative costs.

States can leverage accreditation results for maximum reporting value by using one of the benefits of accreditation…nonduplication.

Nonduplication and the Newly Available 2020 Medicaid Managed Care Toolkit

Nonduplication has a two-fold aim to lessen administrative burden on states while making certain relevant information is available to External Quality Review Organizations (EQRO) for the annual External Quality Review (EQR). In fact, according to the 2016 Medicaid Managed Care Federal Rule…”states could elect to allow all 552 MCOs, PIHPs, and PAHPs to substitute information from a Medicare or private accreditation review for the three mandatory EQR-related activities.”

States document their intent to use nonduplication by detailing it in their Quality Strategy.

NCQA has many tools available to states as they exercise nonduplication, including the 2020 Medicaid Managed Care Toolkit. The toolkit is available here and maps all NCQA Health Plan Accreditation standards (including add-on modules) to the federal rule requirements. NCQA Accreditation aligns with 78% of federal requirements eligible for nonduplication.

As states evaluate how best to use their accreditation mandate, feel free to contact NCQA’s State Affairs Department at

Watch the Webinar

The full recorded webinar is available here.

Section background
Section graphic
Section element
Section element
Stay Informed

Get updates, announcements and trending topics

Join 35k+ health care professionals