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2018 Health Plan Medicaid Module

Improve your opportunity for state deeming by applying for NCQA’s 2018 Health Plan Medicaid Module.

The NCQA Health Plan Medicaid Module helps Medicaid health plans meet federal regulations for state-administered Medicaid programs. Plans that meet module requirements can seek a streamlined review by the state, as allowed under federal Medicaid rules.

Benefits to health plans:

  • Streamline compliance activities. Compliance activities are reduced when the state uses NCQA Health Plan Accreditation and Medicaid Module standards as part of the Medicaid quality review.
  • Become more efficient. Reallocate key quality review resources to other Medicaid priorities.

States can use an accreditor’s review to validate plans that meet federal requirements. This process is known as “deeming.” States use the federally deemable elements in the NCQA Medicaid Module to streamline plans’ oversight reviews.

Medicaid Managed Care Rule Alignment

The Medicaid Module standards are a combination of existing NCQA Medicaid requirements and new requirements. They increase alignment with existing regulatory requirements and strengthen existing deeming opportunities. NCQA analyzed changes to state and federal requirements for the Medicaid Managed Care program, as outlined in the Medicaid Managed Care Rule. The module’s Medicaid-specific standards supplement NCQA Health Plan Accreditation, to maximize alignment.

Eligibility

Organizations with an NCQA-Accredited Medicaid product line and organizations seeking accreditation for the Medicaid product line under NCQA Health Plan Accreditation are eligible.

Apply for the Module

To apply, use the web-based application process to complete the Health Plan Accreditation application for your Medicaid product line and select the Medicaid Deeming Survey option.