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HHS: NCQA, URAC May Be First Exchange Plan Accreditors

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The National Committee for Quality Assurance (NCQA) and URAC may get the job of deciding which health plans meet basic health insurance exchange quality standards by default.

The NCQA, Washington, and URAC, Washington, should get the exchange plan accreditation job because it looks as if they can handle the job, according to the U.S. Department of Health and Human Services (HHS).

HHS officials talk about accrediting plan accreditors in the preamble to a proposed rule that deals with Patient Protection and Affordable Care Act (PPACA) implementation issues.

Opponents of PPACA are fighting implementation of the law in Congress and in the courts.

If PPACA is implemented as written and works as drafters expect, it will set up a new system of health insurance exchanges, or Web-based health insurance supermarkets. One PPACA provision, PPACA Section 1311(c)(I)(D)(i), requires that a “qualified health plan” (QHP) that sells coverage through a PPACA exchange be “accredited with respect to local performance on clinical quality measures,” HHS officials say in the proposed rule preamble, citing the text of PPACA.

“At this time,HHS has determined that recognizing entities through an interim phase one process is necessary to meet the timeline for exchange QHP certification activities, which commence in early 2013 and may include the accreditation requirement, depending on the timeline established by an exchange,” HHS officials say.

Eventually, the officials say, HHS wants to set up a formal application process and public notice approach for would-be accrediting entities, officials say.

But for now, officials say, HHS will pick the NCQA and URAC as the initial accreditors because both groups seem to meet the standards for accreditors set by PPACA, and the majority of people in private health plans are already in plans accredited by the NCQA, URAC or both, officials say.

Officials are asking whether there other entities comparable to the NCQA and URAC that could also serve as initial exchange plan accreditors.

Officials also include an outline in the proposed rule of the process HHS would use to gather the small group plan benefits information HHS would need to create the “essential health benefits” (EHB) list required PPACA.

HHS and  the exchanges would use the EHB list as a kind of yardstick that consumers and others could use  to compare benefits packages.

HHS has come up with several different approaches that a state could use to pick three benchmark plans in its jurisdiction.

The “relevant issuers” would have to provide plan enrollment data along with information about the kinds of medical benefits they offer, any treatment limitations they impose, the drugs they cover, and the rules that apply to their prescription drug programs.


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