ADVISORY COMMITTEE TO CONSIDER UPDATES TO NCQA ACCREDITATION FOR MEDICAID MANAGED CARE PLANS

Changes to reflect state and Federal requirements, service to diverse populations

WASHINGTON – The National Committee for Quality Assurance (NCQA) today announced that it will convene a panel of leading experts on Medicaid managed care to consider updates to NCQA’s Accreditation program for Medicaid health plans. NCQA Accreditation is the health care industry’s most rigorous and most utilized yardstick for health plan quality. Currently, 77 health plans serving Medicaid populations hold NCQA Accreditation.

The panel will consider the special needs of populations served by Medicaid and the Children’s Health Insurance Program (CHIP) programs, as well as health plans that participate in such programs and the needs of state Medicaid programs that contract with plans. An updated set of standards is expected in mid-2010.

“Health plans serving Medicaid beneficiaries play a critical role in improving the health of our most vulnerable citizens. We need to examine our programs to ensure they assist these plans in providing the highest quality of care possible,” said NCQA President Margaret E. O’Kane. “The number and type of Americans enrolled in Medicaid and CHIP is growing and changing. NCQA needs to adapt its programs to reflect this.”

Recent federal legislation expands eligibility for CHIP and Medicaid and provides for important new investments in quality measurement and improvement for people covered by those programs. The American Recovery and Reinvestment Act provided states with assistance in covering the costs associated with increased enrollment, and provided incentives to implement and use health information technology. The Children’s Health Insurance Program Reauthorization Act of 2009 includes funding of $45 million over five years for improving child health quality.

“While there are pockets of excellence, the overall quality of service and care for Medicaid populations simply isn’t where it needs to be,” said Lee Partridge, Senior Health Policy Advisor for the National Partnership for Women and Families and Chair of NCQA’s Medicaid Accreditation Advisory Committee. “An updated set of requirements for health plans seeking Accreditation will drive the improvements in service and care that Medicaid beneficiaries need and deserve.”

The expert panel’s input will guide the development of revisions to the standards throughout the rest of the year. Pilot testing and public comment on the proposed changes are scheduled for the early 2010 with final standards released mid-year. The new rules would take effect on July 1, 2011.

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA accredits and certifies a wide range of health care organizations and recognizes physicians in key clinical areas. More than 7 in 10 Americans enrolled in health plans are in an NCQA-Accredited plan. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices.

# # #

MEMBERS OF NCQA’s MEDICAID ACCREDITATION ADVISORY COMMITTEE

Lee Partridge (Chair), Senior Health Policy Advisor, National Partnership for Women and Families

Melanie Bella, MBA, Senior Vice President, Policy and Operations; Center for Health Care Strategies

John Billings, JD, Associate Professor, Health Policy and Public Service, New York University

Barbara Dailey, Director, Division of Quality, Evaluation and Health Outcomes; Centers for Medicare & Medicaid Services

Robyn Hoffmann, RN, MSN, Quality Improvement Consulting Manager, ACS/Rhode Island Department of Human Services

Deborah Kilstein, Director, Quality Management and Operational Support, Association for Community Affiliated Plans

Coleen Kivlahan, MD, Chief Medical Officer, Aetna Medicaid

Ann Kohler, Director, National  Association of State Medicaid Directors

Wendy Long, MD, MPH, Chief Medical Officer, Bureau of TennCare

Cheryl Fish Parcham, Deputy Director of Health Policy, Families USA

Margaret S. Rowland, MD, Chief Medical Officer, CareOregon

Lisa Schaffran, Associate Director, Rhode Island Parent Information Network

Michael Siegel, MD, Vice President for Utilization Management and Quality Improvement, Molina Healthcare

Pamela Siren RN, MPH, Vice President, Quality and Compliance, Neighborhood Health Plan

Vernon K.Smith, PhD, Principal, Health Management Associates

David M. Stevens, MD, MA, Director of the Quality Center, National Association of Community Health Centers and Research Professor, Department of Health Policy, School of Public Health and Health Services, George Washington University