Medicaid Managed Care - U.S. Senate Special Committee on Aging

WHAT PUBLIC
PURCHASERS
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analysis of the NCQA standards, the Bazelon Center does not intend to
endorse the use of any particular accreditation process.
The NCQA Standards for Accreditation of <strong>Managed</strong> Behavioral
Healthcare Organizations encompass standards for
* Quality Management and Improvement (Standards QI I to QI 11)
* Accessibility, Availability, Referral and Triage (Standards AR I to AR 4)
* Utilization Management (Standards UM I to UM 9)
* Credentialing and Recredentialing (Standards CR I to CR 13)
* Members' Rights and Responsibilities (RR I to RR 8)
* Preventive Behavioral Health Services (Standards PH I to PH 4)
* Clinical Evaluation and Treatment Records Standards TR I to TR 3)
In making the move to managed care, states and other public purchasers
should review various proposed standards for managed care entities
serving the public sector and make their own decisions about which
to accept or adapt to their particular circumstances. One approach
would be to draw from the state system's existing standards.
While declining to endorse any entity's specific accreditation standards,
the Bazelon Center does recommend that purchasers who elect to
use the NCQA standards as a base strengthen them in certain critical areas,
listed below. Manypublic purchasers may well wish to go further.
The NCQA standards have the following general shortcomings
with respect to issues of importance to public-sector mental health and
addiction service delivery:
Consumer Involvement
There are no standards for member involvement in the critical decisions
made by the plan (i.e., no requirements for consumer participation
on advisory committees or governing bodies). Further, while the
final standards are an improvement over a draft released for comment in
1996, the requirements for members to be involved in various aspects of
the plan, or to receive information on critical aspects, are minimal.
Public Information
A contract to-provide public-sector services must operate in a far
more open way than a contract with an employer. NCQA fails to ad-
NCQA Accreditation Standards for <strong>Managed</strong> Behavioral Healthcare Organizations
POLICY ANALYSIS BY THE BAZELON CENTER FOR MENTAL HEALTH LAW
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