Medicare Advantage Deeming
Health Plans that earn NCQA Medicare Advantage deeming are deemed for Medicare requirements for Special Needs Plan Model of Care requirements.
CMS’ Model of Care (MOC) requirements for Special Needs Plans (SNPs) help ensure that plans can meet the needs of all members of their high-need population. NCQA’s Medicare Advantage Deeming module evaluates how SNP plans implement their model of care, including under- and over- utilization of services. Organizations that meet NCQA SNP deeming module requirements are deemed for Medicare requirements for SNP MOC.
This means:
- If a plan gets audited by CMS, then CMS can bypass auditing the Model of Care requirements, as the plan has already demonstrated meeting the requirements through NCQA.
- Plans know their model of care is set up to help meet the unique needs of this high need, high cost population.
- Plans earn the NCQA seal, which they can display in marketing and advertising materials as a quality and trust marker.
If your organization is not currently accredited and is interested in learning more, contact NCQA.
If you already are accredited and want to talk to someone about your current status or about renewing, submit a question through My NCQA.