The National Committee for Quality Assurance received authority to accredit PPOs in the Medicare Advantage program, creating new competition for the Joint Commission on Accreditation of Healthcare Organizations and the Accreditation Association for Ambulatory Health Care, which have held deeming status for Medicare PPOs since 2002.
The CMS' deeming program allows health plans in the Medicare Advantage program, formerly known as Medicare+Choice, to satisfy most federal certification requirements with accreditation by an approved third party instead of going through a full CMS audit.
The NCQA's new designation comes just prior to an expected surge in the number of regional PPOs in Medicare Advantage. The CMS predicts that almost 30% of Medicare beneficiaries will be enrolled in either an HMO or PPO by 2010, up from about 11% today.
The NCQA, which in January 2002 became the first private accreditor to win deeming status for Medicare HMOs, accredits 50 of the roughly 150 HMOs in the federal program. The AAAHC accredits about 20. The JCAHO could not provide a comparable number by deadline but in 2002 accredited nine Medicare plans.