{"id":1207,"date":"2018-06-12T08:59:37","date_gmt":"2018-06-12T12:59:37","guid":{"rendered":"https:\/\/www.ncqa.org\/?page_id=1207"},"modified":"2020-11-24T13:38:57","modified_gmt":"2020-11-24T18:38:57","slug":"maximizing-the-use-of-accreditation","status":"publish","type":"page","link":"https:\/\/www.ncqa.org\/public-policy\/maximizing-the-use-of-accreditation\/","title":{"rendered":"Maximizing the Use of Accreditation"},"content":{"rendered":"<h2>Supporting\u00a0a\u00a0State\u2019s Quality\u00a0Priorities<\/h2>\n<p>NCQA is always ready to help states identify the best way to meet their quality goals.<\/p>\n<p>The approach varies by state: It could mean requiring NCQA Health Plan Accreditation (HPA), using our HEDIS<sup>\u00ae<\/sup>\u00a0quality measures to institute a value-based payment arrangement for providers and\/or plans, or any number of other possibilities. Regardless, our Public Policy team works closely with state officials to find the right solution.<\/p>\n<blockquote><p>\u201cThere was a big effort for the health care industry to really bring to life a common credentialing system for the collection and verification of practitioner information\u2026 We are using a certified Credentialing Verification Organization\u2014they are certified with NCQA. We\u2019ve been working with NCQA since the beginning basically mapping out our program requirements.\u201d Melissa\u00a0Isavoran, Oregon Health Authority\u2014Office of Health Information Technology.<\/p><\/blockquote>\n<h2>Supporting States\u00a0With Medicaid Managed Care<\/h2>\n<p>Managed care is an increasingly popular tool for states seeking to standardize quality and\u00a0control costs\u00a0in Medicaid.\u00a0 NCQA programs are widely used to support these objectives, hold private health plans accountable and help plans improve their performance.<\/p>\n<h3>Using NCQA Health Plan Accreditation (HPA) to Ensure Quality<\/h3>\n<p>Twenty-seven states require that health plans serving their Medicaid population be accredited by NCQA &#8211; with seven others accepting our HPA as meeting broad accreditation requirements.<\/p>\n<p>Beyond simply requiring HPA, twelve states use the results of the accreditation process to satisfy federal oversight requirements. Invoking Medicaid&#8217;s &#8220;non-duplication&#8221; provisions (also know as &#8220;deeming&#8221;) allows states to:<\/p>\n<ul>\n<li>Simplify\u00a0administrative review efforts.<\/li>\n<li>Reallocate\u00a0resources to other priority projects.<\/li>\n<li>Demonstrate\u00a0their\u00a0commitment to maximizing limited oversight resources.<\/li>\n<li>Acknowledge health plans that have gone through the rigorous NCQA accreditation process.<\/li>\n<\/ul>\n<p><em><strong>State Spotlight:<\/strong><\/em> Read how Tennessee Medicaid (TennCare) is maximizing oversight resources by deeming accredited plans\u00a0<a href=\"http:\/\/blog.ncqa.org\/movements-in-medicaid-tennessee\/\" target=\"_blank\" rel=\"noopener noreferrer\">here.<\/a><\/p>\n<h3>HPA Medicaid Module<\/h3>\n<p>In 2018\u00a0NCQA added the Medicaid Module to our HPA program. The module enables plans that meet its expanded requirements to seek a\u00a0broad-spectrum,\u00a0streamlined review by the state, as allowed under federal Medicaid rules. NCQA&#8217;s Medicaid Managed Care Toolkit (see below) includes information on adding the Medicaid Module.<\/p>\n<p>For more information on NCQA\u2019s HPA Medicaid Module, click\u00a0<a href=\"\/programs\/health-plans\/health-plan-accreditation-hpa\/medicaid-module\/\"><u>here.<\/u><\/a><\/p>\n<h3>Medicaid Managed Care Toolkit<\/h3>\n<p>Each year, NCQA publishes the Medicaid Managed Care Toolkit showing states what NCQA Health Plan Accreditation standards can be mapped to external quality review activities.<\/p>\n<p>Slightly more than 75% of NCQA standards overlap with mandatory external quality review activities. As noted above, plans that have met these standards through NCQA accreditation may be deemed as complying with federal requirements.<\/p>\n<p>Download the toolkit <a href=\"http:\/\/store.ncqa.org\/index.php\/catalog\/product\/view\/id\/3742\/s\/2019-medicaid-managed-care-toolkit\/\">here.<\/a><\/p>\n<h3>States and LTSS<\/h3>\n<p>States are increasingly looking to managed care and value-based purchasing to meet the needs of Long-Term Services and Supports (LTSS) recipients.\u00a0 More than 5 million people receive LTSS through the Medicaid program.<\/p>\n<p>NCQA has developed two programs that work to improve the quality of care\u00a0for this population.\u00a0 Already a number of states are requiring participants in their LTSS initiatives to go through one or both of these programs.<\/p>\n<h4 style=\"text-align: left;\"><u>Health Plans<\/u>: Long-Term Services and Supports (LTSS) Distinction for Medicaid Managed Care\u00a0Plans.<\/h4>\n<p style=\"text-align: left;\">LTSS Distinction provides a standardized framework for holding plans and managed behavioral healthcare\u00a0organizations\u00a0(MBHO)\u00a0accountable for managing and coordinating\u00a0LTSS.<\/p>\n<p style=\"text-align: left;\">What\u2019s the value to states?<\/p>\n<ul>\n<li style=\"text-align: left;\">Standardizes\u00a0the\u00a0model of care for plans and MBHOs\u00a0that\u00a0manage\u00a0and coordinate\u00a0LTSS.<\/li>\n<li style=\"text-align: left;\">Complements\u00a0existing NCQA Health Plan Accreditation requirements.<\/li>\n<li style=\"text-align: left;\">Aligns\u00a0with LTSS provisions in\u00a0the\u00a02016 Medicaid managed care rule.<\/li>\n<li style=\"text-align: left;\">Enhances\u00a0state Medicaid managed care quality strategy efforts.<\/li>\n<li style=\"text-align: left;\">Demonstrates\u00a0a\u00a0commitment to integrating\u00a0care and improving\u00a0outcomes for the\u00a0Medicaid\u00a0population.<\/li>\n<\/ul>\n<p><em><strong>State Spotlight:<\/strong><\/em>\u00a0Read more on\u00a0how Kansas is ensuring\u00a0quality for LTSS <a href=\"http:\/\/blog.ncqa.org\/kansas-medicaid-managed-care-includes-ncqa-ltss-distinction\/\" target=\"_blank\" rel=\"noopener noreferrer\">here.\u00a0<\/a><\/p>\n<p>For more information on the LTSS Distinction, <a href=\"https:\/\/www.ncqa.org\/programs\/health-plans\/long-term-services-and-supports\/ltss-distinction-for-health-plans\/\">visit our program page here.<\/a><\/p>\n<h4>Case Management for Long-Term Services and Supports (CM-LTSS) for Community-Based Organizations.<\/h4>\n<p>States are raising the bar to hold organizations such as Area Agencies on Aging and\u00a0Other Community-Based Organizations accountable for coordinating and managing care for the population that needs LTSS.<\/p>\n<p>What\u2019s the value to states?<\/p>\n<ul>\n<li>Standardizes\u00a0the\u00a0model of care for managing LTSS.<\/li>\n<li>Promotes\u00a0efficiency and improves outcomes.<\/li>\n<li>Prepares\u00a0organizations for managed care.<\/li>\n<li>Demonstrates\u00a0an organization\u2019s\u00a0readiness to be a trusted LTSS partner.<\/li>\n<li>Drives\u00a0integrated care.<\/li>\n<li>Aligns\u00a0with\u00a0LTSS provisions in\u00a0the\u00a02016 Medicaid managed care rule.<\/li>\n<li>Enhances\u00a0a\u00a0state\u2019s\u00a0quality strategy\u00a0and\u00a0value for contracting with plans.<\/li>\n<\/ul>\n<p><a name=\"more\"><\/a>Find more details on the Case Management for LTSS Accreditation <a href=\"https:\/\/www.ncqa.org\/programs\/health-plans\/long-term-services-and-supports\/accreditation-of-case-management-for-ltss\/\">here.<\/a><\/p>\n<h2>Other Uses of Accreditation<\/h2>\n<h3>Plan Oversight &amp; Contracting: Insurance &amp; Public Employee Benefits Agencies<\/h3>\n<p>Thirty-three states in the commercial market\u2014including Departments of Insurance and Public Employee Benefit Programs\u2014require or recognize NCQA Health Plan Accreditation to promote high quality care for consumers.\u00a0See the map of states\u00a0and a full list of state requirements\u00a0<a href=\"https:\/\/www.ncqa.org\/wp-content\/uploads\/2020\/02\/20200228_HPA_Commercial_Use.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">here.<\/a><\/p>\n<p>&nbsp;<\/p>\n<h3>Public Reporting: Making Informed Choices<\/h3>\n<p>States and the federal government use accreditation and HEDIS\u00ae in their report cards to help people make apples-to-apples comparisons when choosing a health plan. It is also being used by states and Medicare to adjust payment to reward plans for quality.<\/p>\n<p>Currently 41 states have HEDIS reporting and all Medicare Advantage\u00a0plans report their performance. Results are included in Star Ratings on the quality of each plan.<\/p>\n<p>Results show that\u00a0NCQA-Accredited plans perform better. Our plans deliver better care at a statistically significant level on several critical measures, including\u00a0access to care,\u00a0diabetic blood sugar control,\u00a0cholesterol\u00a0and blood pressure\u00a0control,\u00a0breast and colorectal cancer screening,\u00a0and\u00a0counseling enrollees on nutrition and physical activity.<\/p>\n<p>&nbsp;<\/p>\n<h3>Medicare Advantage Deeming<\/h3>\n<p>Medicare also has authority\u00a0to\u00a0use\u00a0a plan\u2019s\u00a0NCQA\u00a0accreditation\u00a0status\u00a0as proof that a plan has met\u00a0program requirements\u00a0in areas like\u00a0quality improvement, access to care and privacy.\u00a0This\u00a0process,\u00a0known as deeming\u00a0or non-duplication, allows\u00a0plans\u00a0and the federal government to avoid duplicative\u00a0reviews and focus on other enforcement priorities.<\/p>\n<p>We\u00a0are now working to apply this authority to Medicare Advantage Special Needs\u00a0Plans\u00a0(SNPs)\u00a0through a program\u00a0in\u00a0which\u00a0NCQA\u00a0could verify for Medicare that the plans are\u00a0implementing the models of\u00a0care their enrollees need.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Supporting\u00a0a\u00a0State\u2019s Quality\u00a0Priorities NCQA is always ready to help states identify the best way to meet their quality goals. The approach varies by state: It could mean requiring NCQA Health Plan Accreditation (HPA), using our HEDIS\u00ae\u00a0quality measures to institute a value-based payment arrangement for providers and\/or plans, or any number of other possibilities. Regardless, our Public [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"parent":751,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page.php","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-1207","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Maximizing the Use of Accreditation - NCQA<\/title>\n<meta name=\"description\" content=\"NCQA\u2019s State Affairs team works with policymakers to drive health care quality and efficiency by leveraging our accreditation programs.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ncqa.org\/public-policy\/maximizing-the-use-of-accreditation\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Maximizing the Use of Accreditation - NCQA\" \/>\n<meta property=\"og:description\" content=\"NCQA\u2019s State Affairs team works with policymakers to drive health care quality and efficiency by leveraging our accreditation programs.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ncqa.org\/public-policy\/maximizing-the-use-of-accreditation\/\" \/>\n<meta property=\"og:site_name\" content=\"NCQA\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/NCQA.org\" \/>\n<meta property=\"article:modified_time\" content=\"2020-11-24T18:38:57+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.ncqa.org\/wp-content\/uploads\/2021\/04\/NCQA_cmyk_tag.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"627\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:site\" content=\"@NCQA\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.ncqa.org\/public-policy\/maximizing-the-use-of-accreditation\/\",\"url\":\"https:\/\/www.ncqa.org\/public-policy\/maximizing-the-use-of-accreditation\/\",\"name\":\"Maximizing the Use of Accreditation - NCQA\",\"isPartOf\":{\"@id\":\"https:\/\/www.ncqa.org\/#website\"},\"datePublished\":\"2018-06-12T12:59:37+00:00\",\"dateModified\":\"2020-11-24T18:38:57+00:00\",\"description\":\"NCQA\u2019s State Affairs team works with policymakers to drive health care quality and efficiency by leveraging our accreditation programs.\",\"breadcrumb\":{\"@id\":\"https:\/\/www.ncqa.org\/public-policy\/maximizing-the-use-of-accreditation\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.ncqa.org\/public-policy\/maximizing-the-use-of-accreditation\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.ncqa.org\/public-policy\/maximizing-the-use-of-accreditation\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.ncqa.org\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Public Policy\",\"item\":\"https:\/\/www.ncqa.org\/public-policy\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Maximizing the Use of Accreditation\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.ncqa.org\/#website\",\"url\":\"https:\/\/www.ncqa.org\/\",\"name\":\"NCQA\",\"description\":\"Measuring quality. 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