Health Plan Medicaid Module
Improve your opportunity for a streamlined state compliance review by applying for NCQA’s 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.
Streamline compliance activities
If your state implements the federal non-duplication provision, your organization can leverage NCQA Health Plan Accreditation and Medicaid Module results to demonstrate compliance with the federal rule.
If your state implements the federal non-duplication provision, your organization can reallocate key quality review resources to other priorities and special projects.