Accreditation for Plans Participating in Health Insurance Marketplaces
HPA 2013 streamlines the accreditation process by reducing administrative burdens for new and currently accredited health plans. Revised standards and point allocations create three accreditation evaluation options and comprise a “glide path”—flexible opportunities for reaching accreditation, regardless of a plan’s longevity or experience with quality reporting.
- Interim Survey is for plans that need accreditation before or right after they open for business. It focuses on policies and procedures, does not include HEDIS/CAHPS reporting and is valid for 18 months – half as long as the other options.
- First Survey is for plans new to NCQA, and leads to accreditation that is valid for 3 years. HEDIS/CAHPS reporting is required only in year 3 of accreditation. This helps prepare health plans for Renewal requirements.
- Renewal Survey is available to NCQA-Accredited plans seeking to extend their accreditation another 3 years. HEDIS/CAHPS reporting is mandatory and plans are scored based on their performance results
Marketplace Accreditation Updates
NCQA understands the importance of aligning the Centers of Medicare and Medicaid (CMS) Marketplace requirements and NCQA Accreditation requirements. With regard both to requirements for reporting enrollee survey results and HEDIS measure results, NCQA plans to accept results that follow CMS reporting requirements. NCQA will review CMS’ Qualified Rating System beta test results in the fall of 2015 before making final decisions on Marketplace Accreditation reporting requirements for 2016. (Published 11-24-2014)
Which Scenario is Right for Me?
NCQA Customer Resources
Measuring Quality in the Early Years of Health Insurance Marketplaces