A Coordinated Care Plan (CCP) includes a network of providers under contract to deliver the approved benefit package. This package is approved by which entity?

A Coordinated Care Plan (CCP) includes a network of providers under contract to deliver the approved benefit package. This package is approved by which entity?

• A. CMS
• B. NCQA
• C. ACOs
• D. HEDIS

Answer: (A)

The key point is who has the authority to authorize what services are covered in a Coordinated Care Plan. In programs overseen by Medicare and Medicaid, that authority rests with the Centers for Medicare & Medicaid Services. CMS sets the rules for what must be included in the plan’s benefit package and approves the specific benefits the plan is allowed to offer to enrollees. NCQA, on the other hand, is an accrediting and quality-measure organization; it evaluates plans and measures quality, not approve benefits. ACOs are provider networks focused on delivering care, not approving plan benefits. HEDIS is a set of performance measures used to assess quality, not to approve benefits. So the package is CMS-approved.

The key point is who has the authority to authorize what services are covered in a Coordinated Care Plan. In programs overseen by Medicare and Medicaid, that authority rests with the Centers for Medicare & Medicaid Services. CMS sets the rules for what must be included in the plan’s benefit package and approves the specific benefits the plan is allowed to offer to enrollees. NCQA, on the other hand, is an accrediting and quality-measure organization; it evaluates plans and measures quality, not approve benefits. ACOs are provider networks focused on delivering care, not approving plan benefits. HEDIS is a set of performance measures used to assess quality, not to approve benefits. So the package is CMS-approved.