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

ASSESSMENT OF
STANDARDS -
Quality Managerment and
bnprouement
(Standards QI I to QI 11)
784
Procedures section). Public payors should require that NCQA also inform
them in such circumstances.
Corrective Actions
NCQA's requirements for.corrective action generally suggest that
the plan take action. In order to better protect plan members from inadequate
or abusive care, public payors should consider mandating specific
corrective actions for specific circumstances.
Delegation
Throughout the standards are requirements regarding the delegation
of activities and responsibilities to other entities or to network providers.
In none of these instances does NCQA require that the subcontract
between the managed care entity and the other organization be made
available to the public payor and the public. Yet, in the case of a public
* system, these are contracts for public services and should be open to
public scrutiny.
Focus on Process
The standards are very process-oriented, requiring the tracking of
various processes and activities within a managed care plan. However,
there is very little emphasis on true measures.of quality of care, such as
health and mental health outcomes for the members served by the plan.
In addition to these overall concerns, the Bazelon Center has identified
specific additional requirements that should be considered by public
purchasers. This section-by-section analysis highlights the problem
areas in the NCQA standards. However, it does not suggest alternative
or additional standards. Other resources to guide that complex process
are suggested at the end of this paper.
a) Member Satisfaction (QI 4):
NCQA relies on consumer-satisfaction surveys. However, accurate
assessment of member satisfaction and of the problems members have
with their plan requires more than consumer-satisfaction surveys; which
traditionally produce generalized high ratings but fail to uncover specific
information or problems. Purchasers might consider using focus
NCQA Accreditation Standards for <strong>Managed</strong> Behavioral Healthcare Organizations
POLICY.ANALYSIS BY THE BAZELON CENTER FOR MENTAL HEALTH LAW 4