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

Wednesday, August 15th, 2012

Washington, DC – August 15, 2012 – 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.

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.


For 25 years, URAC has been the independent leader in promoting health care quality through accreditation, education, and measurement. URAC offers a wide range of quality benchmarking programs that reflect the latest changes in health care and provide a symbol of excellence for organizations to showcase their validated commitment to quality and accountability. URAC’s evidence-based measures and standards are developed through inclusive engagement with a broad range of stakeholders committed to improving the quality of health care.

For more information about URAC, contact us.

Interested in accreditation?
Contact businessdevelopment@urac.org

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