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URAC Asks HHS to Ensure Accreditation Options for Managed Care Plans Under Medicaid

Wednesday, August 5th, 2015

Last month, URAC President and CEO Kylanne Green wrote to Obama Administration Secretary of Health and Human Services Sylvia Burwell to comment on a proposed rule regarding the roles of states in dealing with the accreditation of managed care plans under Medicaid.

HHS
Green, in her letter to Secretary Burwell, commented on a proposed rule that was published in the Federal Register on June 1, 2015. Green noted that this new regulation is appropriately meant to “harmonize review of Medicaid managed care plans with the process and accreditation standards approved for use in other federally regulated markets.”

Under the proposed rulemaking, there would be two options available to states that are overseeing managed care plans through Medicaid:

  • purchasing a set of accreditation standards and conducting their own extensive reviews;
  • validating managed care plans through existing accreditation they already received from review organizations approved by the federal Centers for Medicare and Medicaid Services (CMS).

Green suggested that any final rulemaking in this area ensure that managed care plan operators have the ability to select any CMS-approved accreditation organization they feel best fits their needs. Without CMS ensuring that managed care plans have choice in accreditation, she pointed out, there is a risk that the rule may be interpreted by state Medicaid agencies to restrict recognition of accreditors – even though multiple entities have received CMS approval.

In URAC’s letter, Green suggest to Secretary Burwell that:

CMS clarify that state Medicaid agencies allow Medicaid managed care plans a choice of accreditor as CMS allows for both Medicare Advantage plans and [Qualified Health Plans]. Without such clarification, the current language could allow a state to dictate a Medicaid managed care plan to undergo a specific accreditation program which is counter to CMS’ regulated managed care markets.

To further clarify the proposed process, Green also suggested that CMS “create a process to review and formally recognize accreditation standards as they map to state’s External Quality Review requirements.”

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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.

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