The NAIC is trying to help states setting up exchanges grapple with data and information-sharing to fulfill a requirement of the Patient Protection and Affordable Care Act concerning Qualified Health Plans.
The PPACA requires QHP issuers to “authorize the accrediting entity that accredits the QHP issue to release to the [state] Exchange and the U.S. Department of Health and Human Services (HHS) a copy of its most recent accreditation survey, together with any survey-related information that HHS may require, such as corrective action plans and summaries of findings.”
This statement and bold type are from an NAIC draft paper, “Exchanges Subgroup: Accreditation & Quality Team,” dated May 16, 2012.
There are no other nationally recognized health plan accrediting bodies at this time, as the NAIC draft paper points out. However, the PPACA doesn’t preclude recognition of other organizations, including state-specific organizations to fulfill the accreditation purposes, the draft paper says. Indeed, the paper suggests that a state can have a unique state-specific accreditation body that could seek HHS recognition.
The paper ponders whether the SERFF NAIC-developed System for Electronic Rate and Form Filings could pinpoint parts of filings or develop summaries as part of the necessary information states would need to review to fulfill the health care reform act’s requirements.
An Exchange also must evaluate quality improvement strategies and oversee implementation of enrollee satisfaction surveys, assessment and ratings of health care quality and outcomes, according to PPACA.
An Exchange website must provide standardized comparative information on each available QHP, including quality ratings. The Exchange is also expected to establish time frames in which QHPs are expected to earn accreditation if they don’t already have it, the paper states.