Health Plan Medicaid Module

NCQA Health Plan Medicaid Module is a program designed to support NCQA-Accredited health plans. Plans that meet NCQA Health Plan Accreditation and NCQA Medicaid Module standards position themselves for a streamlined state compliance review. The Medicaid Managed Care Final Rule’s non-duplication provision allows states to accept information obtained from a nationally-recognized accreditor in lieu of a review by the state or its External Quality Review Organization.

MEDICAID MANAGED CARE RULE ALIGNMENT

The NCQA Health Plan Medicaid Module standards are a combination of existing NCQA Medicaid requirements and new requirements. They increase alignment with existing regulatory requirements and strengthen existing opportunities to receive a streamlined review. NCQA analyzed changes to state and federal requirements for the Medicaid Managed Care program, as outlined in the Medicaid Managed Care Rule. The module’s Medicaid-specific standards supplement NCQA Health Plan Accreditation, to maximize alignment.

HOW DOES MY ORGANIZATION BENEFIT?

Meeting NCQA Medicaid Module standards can help NCQA-Accredited health plans:

• Maximize alignment with the Medicaid Managed Care Rule.
• Position their organization for a streamlined state compliance review.