Health Plan Medicaid Module Requirements
NCQA Health Plan Medicaid Module evaluates an organization’s Medicaid product line under the applicable NCQA Health Plan Accreditation program standards and the Medicaid Module standards.
The combination of existing NCQA Medicaid requirements and new requirements increase alignment with existing regulatory requirements and strengthen existing opportunities to receive a streamlined review.
FOCUS AREAS TO IMPROVE ALIGNMENT
NCQA Health Plan Medicaid Module standards include the following:
- Medicaid Benefits and Services.
- Practice Guidelines.
- Privacy and Confidentiality.
- Care Coordination.
- Practitioner Office Site Quality.
- Initial Assessment of Members.
- UM Decisions About Payment and Services.
To see all program requirements, get the Standards & Guidelines document.
IS MY ORGANIZATION ELIGIBLE?
An organization is eligible for the NCQA Health Plan Medicaid Module if:
- Its Medicaid product line has a current NCQA Accreditation status as a First or Renewal Survey, or
- It is seeking accreditation for its Medicaid product line under NCQA HP Accreditation as an Interim, First or Renewal Survey.
HEALTH PLAN MEDICAID MODULE SUPPORT
Find information about the NCQA Medicaid Module survey here:
- Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review.
- Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organization’s survey readiness—the tool calculates your potential survey score.
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