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Health and Human Services Recommends URAC Accredit Health Plans on Health Insurance Exchanges

July 30, 2012

In a final rule published in the Federal Register, Secretary of Health and Human Services Kathleen Sebelius recommended URAC 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 Health Insurance 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 and final rule make clear that the choice of HHS recognized accrediting entity sits entirely with QHP issuers—regardless of whether the Exchange is Federally-facilitated, State-run, or a Federal/State Partnership. By offering a choice of URAC and one other accrediting entity, HHS is helping ensure accreditation products 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 its competitor 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’ recognition means URAC will play a central role in helping implement Health Insurance 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.”

URAC will be formally submitting the information on its Health Plan Accreditation Program, Version 7, as specified in the final rule, to HHS by August 1, well ahead of the September 18 deadline. Given the fact that HHS already reviewed Version 7 when it was launched in January, URAC is confident that HHS will formalize its recognition of URAC in a forthcoming Federal Register announcement.

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