How NCQA Supports State Quality Programs
Smarter oversight that drives better care while reducing unnecessary burden. NCQA partners with states and CMS to turn policy goals into measurable results.
Quality Solutions for Today's State Challenges
States are facing tighter budgets, smaller workforces and growing program demands—yet the need to maintain and improve quality remains as important as ever. Quality is one of the most effective tools states have to improve outcomes, ensure accountability and maximize the value of public investment. The goal is not more oversight, but smarter oversight.
NCQA partners with states, the Centers for Medicare & Medicaid Services (CMS) and other government stakeholders to help evaluate the quality of care they fund and regulate, while identifying opportunities to drive meaningful improvement. We support Medicaid managed care programs, health plans and providers with practical, proven solutions.
Drawing on decades of experience, NCQA translates complex health policy into clear, operational standards that can be implemented at scale. Through a portfolio of "shovel-ready" programs and tailored solutions, we help states accelerate quality improvement while minimizing administrative complexity.
How NCQA Supports States
- Provides technical expertise on Medicaid managed care regulations and guidance.
- Aligns quality measures and strategies with CMS requirements.
- Supports state quality rating systems and performance oversight.
- Analyzes emerging policy issues impacting Medicaid beneficiaries.
States Using NCQA Programs
NCQA programs help states across the country improve care quality and provider accountability. Because each state has unique quality goals and priorities, program adoption varies. Interact with the map to explore which NCQA programs are used in each state.
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Burden Reduction and Streamlining Quality Oversight
NCQA helps states simplify administrative processes and strengthen quality oversight by aligning standards, measures and reviews across Medicaid, marketplace and Medicare programs.
Benefits of Working With NCQA
Reduces Duplicative Audits
Fewer overlapping reviews across programs save staff time and cost.
Improves Consistency
Aligned standards create consistency across quality programs.
Builds Credibility
Independent review by a nationally recognized third-party authority builds trust.
Clear Expectations
Actionable expectations for managed care organizations.
Maximizing Accreditation Value Through Nonduplication
Federal Medicaid rules allow states to use certain information collected during the NCQA Accreditation process in lieu of state or External Quality Review Organization (EQRO) reviews. This process is known as nonduplication, sometimes called "deeming." States that require NCQA Accreditation streamline MCO oversight and support federal compliance by reducing duplicative reviews, improving operational efficiency and demonstrating a strong commitment to quality.
CMS also recognizes NCQA Accreditation as evidence that Medicare health plans meet key program requirements, including quality improvement, access to care and privacy protections. NCQA is now working to extend this recognition to Medicare Advantage Special Needs Plans (SNPs).
Medicaid Managed Care Toolkit
A practical resource to help states and their quality partners maximize the value of NCQA Accreditation and required HEDIS® and CAHPS® reporting. It outlines how states can leverage federal authority to streamline oversight using private health plan accreditation.
- Actionable guidance for developing and implementing quality strategies.
- Resources to align accreditation, quality measurement and program oversight.
- Best-practice standards designed to improve outcomes for Medicaid populations.
Health Plan Accreditation Medicaid Module
Designed to support NCQA-accredited health plans. Plans that meet both NCQA Health Plan Accreditation and Medicaid Module standards can maximize alignment and position their organizations for streamlined state compliance reviews.
Under the Medicaid Managed Care Final Rule's non-duplication provision, states may accept information from a nationally recognized accreditor in place of separate reviews conducted by the state or its EQRO.
Learn MoreHEDIS® Measurement and Audit Support
NCQA's HEDIS is the most widely used performance measurement system in Medicaid managed care. We support states through comprehensive measure specification and independent HEDIS Compliance Audits to ensure data integrity and consistency—including validation of reported data and assistance with reporting, benchmarking and performance improvement. HEDIS is aligned with CMS quality requirements and external quality review activities.
Ways HEDIS Compliance Audit Reduces Burden
- EQRO protocols allow managed care plans using third-party–certified NCQA HEDIS measures to streamline or waive the resource-intensive verification process.
- For plans undergoing a HEDIS Compliance Audit, EQROs can use accreditation results to fulfill the mandatory Information Systems Capabilities Assessment (ISCA).
Improving Prior Authorization Processes
NCQA continues to update our programs to reflect changes in federal requirements and industry momentum. As the federal government seeks to increase oversight of prior authorization policies and advance readiness for electronic prior authorization and interoperability standards, NCQA proposed enhancements to Health Plan Accreditation to strengthen plan oversight.
Learn MoreProposed Enhancements
- Greater reporting of utilization management and prior authorization performance data.
- Publication of clinical criteria used in decisions.
- Evaluation of prior authorization policies that are routinely approved and may no longer be necessary.
Advancing Rural Health
Rural communities face persistent healthcare access and workforce shortages—nearly one in five Americans lives in a rural area, and about 80% of rural communities are medically underserved. NCQA helps states, rural health systems and providers demonstrate quality, modernize care delivery and turn Rural Health Transformation Program funding into lasting, sustainable improvements.
NCQA Solutions Provide
Access & Availability
Measures that account for access and availability in rural areas.
Telehealth Models
Support for telehealth-enabled care models.
Coordinated Care
Focus on primary care, care coordination and behavioral health access.
Equity-Driven
Equity-driven approaches tailored to rural populations.
Programs Supporting Rural Health
Patient-Centered Medical Home (PCMH) Recognition
The nation's most widely adopted primary care evaluation program with more than 10,000 practices recognized. PCMH supports high-quality, team-based, coordinated care foundational to rural health transformation.
Learn MoreCertified Community Behavioral Health Clinic (CCBHC) Accreditation
A standardized accreditation pathway aligned with SAMHSA certification requirements that promotes consistent implementation, quality oversight and sustainable expansion of the CCBHC model.
Learn MoreVirtual Care Accreditation
A clear roadmap for high-quality virtual primary and urgent care, helping states ensure telehealth investments expand access, advance equity and meet national standards for safety and accountability.
Learn MoreDigital Quality Measurement
Digital quality measures offer states a more efficient, reliable approach by leveraging standardized, interoperable data across systems—enabling real-time insights while reducing manual reporting burden.
Explore the Digital Quality HubResponsible and Effective AI Use
NCQA is developing new AI standards to define trusted frameworks for healthcare, convening an AI Governance Working Group to build consensus on safety, privacy, transparency and governance requirements for responsible AI use.
Learn MoreEnhanced Quality Reporting
State Digital Quality Infrastructure
NCQA's Digital Content Services and Digital Quality Solutions can play a central role in helping states build and scale digital quality infrastructure by supporting standardized, interoperable data and measurement.
NCQA Data Quality Solutions
Data Quality Solutions (DQS) help states ensure clinical data is accurate, complete and usable early in the data lifecycle—so it can reliably support Medicaid reporting, oversight and digital quality initiatives. Built on national standards, DQS enables automated, upstream data quality checks that reduce provider burden and strengthen program integrity.
Learn MoreDigital HEDIS
NCQA's suite of standardized, computable quality measures built on FHIR® and Clinical Quality Language (CQL). These interoperable standards help states modernize Medicaid and public health reporting, reducing manual burden and integrating measurement directly into existing workflows—for organizations at any stage of digital readiness.
Learn MoreBenchmarking and Dashboards
NCQA benchmarks are used to evaluate and compare the performance of health plans across the U.S., primarily based on HEDIS and CAHPS measures. States can use benchmarks to assess health plan and provider performance against national standards, identify gaps in care and guide quality improvement and resource allocation.
Quality Compass®
A leading benchmarking tool for evaluating health plan performance using HEDIS and CAHPS measures. It enables government purchasers to monitor plan performance across Medicaid, Medicare, Exchange and commercial markets, meet federal Medicaid and CHIP Quality Rating System requirements, and inform value-based payment and procurement decisions.
Learn MoreDual Eligible Special Needs Plans (D-SNP) Data Sets
Clear insight into D-SNP performance through national, regional and state benchmarks, along with plan-level data at the Medicare Advantage contract level. Designed for comparative analysis to help states track trends and make informed decisions for this complex, growing population.
Order NowMAC QRS Implementation Support
The Medicaid and CHIP Quality Rating System (MAC QRS) is a federally mandated initiative that requires states to publicly report results for mandatory quality measures for Medicaid and CHIP managed care plans by December 31, 2028. NCQA offers comprehensive support to streamline MAC QRS implementation and reporting:
- 1Standardized data collection for the full MAC QRS mandatory measure set—HEDIS, CAHPS and non-HEDIS measures.
- 2Streamlined reporting solutions that reduce administrative burden and minimize variation across states.
- 3Independent audit services to validate data accuracy and completeness.
- 4Measure-level performance calculations aligned with CMS definitions of quality ratings.
- 5Flexible collaboration to align with preferred data submission and reporting workflows.
Ready for the December 31, 2028 deadline? NCQA works closely with states to deliver efficient, consistent and reliable MAC QRS reporting.
Learn MoreLatest Blog Articles From NCQA
On-Demand Webinars for States
NCQA Fireside Chat, Featuring Assemblywoman Tracy Brown-May
Updates to PCMH Recognition and Medicaid Managed Care Oversight
Contact Us
Ready to bring smarter, streamlined quality oversight to your state? Our State Quality Solutions team is here to help you turn policy goals into measurable results.
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