NCQA Accreditation and the New York State Health Home Implementation for Managed Care Plans

NCQA has recently published guidance related to accreditation for health plans that are participating with state Medicaid agencies in the implementation of Health Home programs. This information supplements the Technical Assistance Tool, "Implications of Health Homes for NCQA Health Plan Accreditation", published on line at the Integrated Care Resource Center. This information is important for plans in New York State who are participating in the Health Home implementation that are NCQA accredited. In the Health Home project, the health plan is delegating an NCQA standard activity to a, generally, non-NCQA recognized provider. Delegation under the NCQA standards has very specific requirements which include pre-delegation evaluations, delegation agreements and monitoring activities. NCQA is allowing certain short term modifications to requirements for managed care plans implementing a Health Home. The application of these modifications will vary by plan structure and time in the accreditation cycle. It is important for plans to have their accreditation specialist review these documents and communicate directly with NCQA to determine the applicability of these modifications to the particular plan. The New York State Department of Health will provide to requesting plans documentation that the Health Homes working with their plans are approved by the state for this purpose and the nature of the funding structure for Health Home activities.