Managed Behavioral Healthcare Organization Accreditation Requirements

FOCUS AREAS TO ENSURE HIGH QUALITY

The standards, provide a framework for implementing best practices to improve:

• Quality Management and Improvement: Monitors, evaluates and improves the quality and safety of care.
• Care Coordination: Coordinates medical care and behavioral healthcare for its members.
• Utilization Management: Notifies members and practitioners about coverage decisions within required time frames.
• Credentialing and Recredentialing: Verifies the credentials of the practitioners in its network.
• Members’ Rights and Responsibilities: Has a written members’ rights and responsibilities policy.

To see the program requirement details, get the Standards & Guidelines document.

REQUIRED ORGANIZATION SERVICES

The standards are designed for organizations providing comprehensive managed behavioral health care services but are not specific regarding the types of behavioral services.

IS MY ORGANIZATION ELIGIBLE?

Any organization that provides managed health care services may apply for the NCQA Managed Behavioral Healthcare Organization Accreditation if it meets the following criteria:

• Has been in operation for at least six months, and
• Enrolls or receives enrollment of an identifiable eligible population that is eligible to access the network, and
• Provides comprehensive behavioral health care services through an organized delivery system across a continuum of care, and
• Performs functions addressed in the standards (quality improvement, care coordination, utilization management, credentialing, member rights and responsibilities), either directly or through a service agreement, and
• Has a process for monitoring, evaluating and improving the quality and safety of care.

RELATED PROGRAMS

NCQA offers several related programs for organizations eligible for the Managed Behavioral Healthcare Organization Accreditation. Each program helps organizations improve their operations and initiatives in targeted areas and demonstrate their commitment to quality.

Long-Term Services and Supports Distinction

NCQA offers a Long-Term Services and Supports (LTSS) Distinction for organizations who provide managed health services and coordinate social services for LTSS.

The standards provide a framework for organizations to deliver effective person-centered care that meets people’s needs and aligns with state requirements.

Learn more about NCQA LTSS Distinction for Health Plans.

Health Equity Accreditation Programs

Health Equity Accreditation Programs focus on the foundation of health equity work: building an internal culture that supports the organization’s external health equity work; collecting data that help the organization create and offer language services and provider networks mindful of individuals’ cultural and linguistic needs; identifying opportunities to reduce health inequities and improve care.

Learn more about NCQA Health Equity Accreditation for Health Plans.