HHS issues accreditation related items in proposed rule

Update: March 7, 2013 - HHS releases essential health benefits, actuarial value, and accreditation final rule

Dec. 27, 2012

On November 20, 2012 the Department of Health and Human Services (HHS) released a proposed rule amending the July 20, 2012 Final Rule for Recognizing Entities for Accreditation. Comments due on December 26, 2012.

What has changed?

The proposed rule now permits accrediting entities in addition to the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC) to apply for recognition to accredit QHP issuers during the initial phase of an insurer’s accrediting process.  Additionally, the proposed rule finalized the timeline for QHP accreditation for purposes of Federally-facilitated or state-partnership exchanges, as explained below.

What are the requirements to become accredited?

The following requirements apply to Qualified Health Plan (QHP) issuers with commercial, Medicaid or Exchange products that have not been accredited:

  • During a QHP issuer’s initial year of certification, it must have scheduled or plan to schedule a review of QHP policies and procedures with an accrediting entity.
  • In the QHP issuer’s second and third years of certification, the issuer must be accredited on the policies and procedures that are applicable to its Exchange products, or a QHP issuer must have commercial or Medicaid health plan accreditation and the administrative policies and procedures underlying that accreditation must be similar to the administrative policies and procedures used in connection with the QHP.
  • Full compliance with accreditation guidelines will not be required until the QHP issuer’s fourth year of certification.

How will HHS certify QHPs as having received accreditation?

The accrediting entities must submit documentation to HHS to demonstrate that the plan meets the conditions for recognition. NCQA and URAC have completed all the steps necessary to be recognized as accrediting entities.

What is Blue Cross doing?

Blue Cross Blue Shield of Michigan is continuing to pursue NCQA accreditation. BCN has been NCQA accredited for several years.

Where can I find more information?

For more information, please see Accreditation of QHP Issuers Section 156.275 of the Code of Federal Regulations.

The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by U.S. Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.

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