HHS Nominates URAC to Accredit Health Plans on Health Insurance Exchanges in All 50 States and DC

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In a final rule published in the Federal Register on July 20, 2012, the Secretary of Health and Human Services nominated URAC to serve as an HHS recognized accrediting entity of Qualified Health Plan (QHP) issuers participating on Health Insurance Exchanges.

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In a final rule published in the Federal Register on July 20, 2012, the Secretary of Health and Human Services nominated URAC to serve as an HHS recognized accrediting entity of Qualified Health Plan (QHP) issuers participating on Health Insurance Exchanges. The Affordable Care Act (ACA) mandates that Exchanges begin operation in all 50 states and the District of Columbia on January 1, 2014, and also requires that all QHP issuers wishing to participate on an Exchange obtain accreditation from any accrediting entity recognized by HHS.

The ACA, final rule, and subsequent HHS clarification make clear that:

  •     The choice of HHS recognized accrediting entity sits entirely with QHP issuers, and not the local Exchange.
  •     Issuer choice of HHS recognized accrediting entities applies to all 50 states and DC, regardless of whether the Exchange is Federally-facilitated, State-run, or a Federal/State Partnership.
  •     Issuer Exchange participation will be equally assured and recognized by HHS, whether using URAC’s or NCQA’s health plan accreditation program.

By offering a choice of URAC and NCQA, HHS is helping ensure accrediting entities compete on quality and price, allowing each issuer to select the one that best fits their needs and resources. HHS is also seeking new ways to measure health plan quality and rate plan performance, and is looking to URAC and NCQA for fresh approaches in these critical areas, which will ultimately be specified in future rulemaking.

“URAC is extremely pleased HHS intends to formally recognize our new Exchange-ready Health Plan Accreditation Program, which was designed to meet all ACA requirements, and continues the URAC tradition of putting consumers and quality first,” said Alan P. Spielman, URAC’s President and CEO. “HHS’s recognition means URAC will play a central role in helping implement Exchanges in all 50 states and DC, and validates the input and hard work of cross-industry experts in creating a robust, Exchange-ready accreditation product of which we can all be proud.”

As required in the final rule, URAC will be formally submitting information on its Health Plan Accreditation Program, Version 7, to HHS in the near future. URAC is pleased that the final rule acknowledges Version 7 was released in January of 2012 and was the basis for HHS’s determination that URAC has “already issued accreditation standards that meet the conditions for recognition…” Given HHS’s initial review of Version 7 when it was launched in January 2012, URAC is confident that HHS will formalize its recognition of URAC in a forthcoming Federal Register announcement.

URAC is fully geared up to begin accrediting QHP issuers for Exchange participation as soon as HHS makes it formal recognition announcement, which is expected by Fall 2012.

About URAC
URAC, an independent, nonprofit organization, promotes health care quality through its accreditation, education and measurement programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system and provides a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information, call (202) 326-3943, or visit http://www.urac.org and our Twitter and LinkedIn sites.

Join us for URAC’s Annual Quality Summit and Awards Program, October 9-11, 2012, Parc 55 Wyndham San Francisco – Union Square, San Francisco, CA. Visit https://www.urac.org/13thAnnualSummit/13thAnnualSummit.asp for more information.

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Jessica Lutz
URAC
(202) 326-3967
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