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NCQA Releases 2018 Health Plan Medicaid Module

Reduces burden for Medicaid organizations and health plans

April 5, 2018

WASHINGTON, DC—The National Committee for Quality Assurance (NCQA) announces the release of the 2018 Health Plan Medicaid Module. The Medicaid Module reduces the burden on state Medicaid programs and their contracted Medicaid plans so resources can be used where they are most needed: on beneficiaries.

How the Health Plan Medicaid Module works:

The module aligns with the 2016 federal Medicaid Managed Care (MMC) Rule. Medicaid health plans who demonstrate they meet the requirements in the module also demonstrate alignment with federal requirements for Medicaid plans.

States can then use that accreditation information for their annual quality review of plans. This ensures the quality is maintained and brings efficiency to Medicaid programs and Medicaid plans by reducing their burden.

Standards in the current NCQA Medicaid Module are for 2018 Health Plan Accreditation.

Benefits of the 2018 Health Plan Medicaid Module:

  • Simplifies administrative review efforts (i.e., reduces staff time).
  • Promotes efficiency (i.e., allows the reallocation of quality review resources to other priorities).
  • Demonstrates commitment to compliance with the Medicaid Managed Care Rule requirements.

Background:

In 2016, CMS released the MMC, updating its longstanding set of requirements for managed care organizations that serve Medicaid populations. This rule modernizes requirements for Medicaid to align with Medicare, Marketplace and some commercial requirements.

NCQA analyzed changes to state and federal requirements for the CMS Medicaid Managed Care program, and developed the Medicaid deeming standards to increase alignment with existing regulatory requirements and to strengthen existing deeming opportunities for organizations. The standards are a combination of existing NCQA Medicaid requirements and new requirements, developed through a comprehensive review of the MMC, NCQA Standards Committee discussions and feedback from our Public Comment period.

Encouraging States’ Participation

NCQA encourages states to make the most of the federal option to deem accreditation findings. States can use the federally deemable elements cross-walked to the NCQA Medicaid HP Accreditation standards and the NCQA Medicaid Module to streamline their plan’s oversight reviews.

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