Accrediting Qualified Health Plan Requires Accessible Data, Image, Courtesy AP

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.

But the draft of the paper says that a state exchange does not appear to have clear authority to compel the accrediting bodies to furnish all information that state officials might want—a potential obstacle in an exchange’s attempt to fulfill its requirement to oversee quality improvement programs.

Instead, states would have to rely on HHS to share information or on authority over the health plans to share information. States may also pursue state laws compelling accrediting bodies to directly share information, the draft paper states.

SERFF is currently involved in discussions with the various accrediting organizations regarding its role as a data conduit for states.

Another way to get data to the exchanges would be through the NAIC’s Market Conduct Annual Statement (MCAS), assuming large data sets are involved. The paper notes, however, that MCAS is not currently used for health insurance.

In states where the Exchange is not overseen by a department of insurance or in states where there is a federally facilitated exchange, these platforms may not be as obvious. So states may wish to strategize to promote these platforms as a means to harmonize with overlapping state insurance department and exchange activities, the paper notes.

As of the date of the draft paper, several states with established exchanges have had varying experience in establishing time frames for unaccredited plans to become accredited, it points out. Oregon and North Carolina have Exchanges, for example, but have not dealt with the issue of establishing a time frame for unaccredited plans to become accredited, the paper says.

There will be an Exchanges (B) Subgroup Marketing & Consumer Information Team conference call May 31. Comments are due on the Accreditation Quality Draft Paper May 29.