Medicare Advantage Deeming
The Centers for Medicare & Medicaid Services (CMS) has granted NCQA deeming authority for the Medicare Advantage (MA) program, Medicare’s managed care program. This authority allows NCQA to review MA organizations on behalf of CMS in six key categories:

  • Access to Services
  • Antidiscrimination
  • Confidentiality and Accuracy of Enrollee Records
  • Information on Advance Directives
  • Provider Participation Rules
  • Quality Assurance

MA organizations that meet NCQA standards for these categories will be compliant with corresponding MA requirements, relieving the plan of redundant oversight.

2009 MA Deeming Program

The content of NCQA’s 2009 MA deeming modules for both MCOs and PPOs has been approved by CMS. Plans may now submit applications and can be scheduled for MA Deeming Surveys under the 2009 standards.

To be eligible for NCQA’s Deeming Program, plans must complete a survey of the Health Plan accreditation standards for their Medicare product line, in addition to standards in the MA deeming module of federal requirements for Medicare plans. For MA organizations, the NCQA Deeming Program consists of the NCQA 2009 HP Accreditation, plus the additional MA Module. The 2009 MA module became effective July 1, 2009.

Contacts

If you have questions about NCQA’s status as a deemed accrediting organization, please contact Kristine Thurston Toppe, Director, Public Policy.

If your organization is interested in finding out more about going through NCQA Accreditation and the NCQA Medicare Deeming Program, please contact NCQA Customer Support at 888-275-7585 or customersupport@ncqa.org.


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  • Policy Updates & Supporting Documents

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Medicare Advantage Deeming Resources

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