Accreditation

All issuers in FFE states must complete the accreditation attestations in the QHP Application and authorize the release of their accreditation survey data from the accrediting entity, if applicable. Issuers in states performing plan management functions and SBE-FPs should comply with the requirements specified by their state.

Key Changes for PY21: 

  • CMS suspended activities related to the collection and reporting of quality improvement information for the Quality Improvement Strategy (QIS) for the Plan Year 2021 QHP Certification Period. Additional information is available in the COVID-19 Marketplace Quality Initiatives Memo (PDF).

Tips for the Accreditation Section

  • If an issuer is entering its initial year of QHP certification, it must schedule (or plan to schedule) a review with a recognized accrediting entity (i.e., AAAHC, NCQA, or URAC). An issuer is not required to be accredited in its initial year of QHP certification.
  • Any information provided on accredited products must be for the same legal entity in the same state that submits the QHP Application.
  • If an issuer is entering its fourth consecutive year of QHP participation, it must be accredited in the Exchange market and with one of the following statuses:
    • AAAHC: Accredited
    • NCQA: Excellent, Commendable, Accredited, or Provisional
    • URAC: Full or Conditional.
  • An issuer must provide its accrediting entities with the issuer legal name and HIOS Issuer ID used in its QHP Application to ensure the HIOS Issuer ID is included in the data file provided by the accrediting entity to CMS.
  • Second year issuers who are not yet accredited can meet the second year requirement by submitting documentation from their accrediting entity that indicates the issuer completed the policies and procedures review and are scheduled or in process for additional review.
  • Use the following naming convention for the accreditation certificate: [HIOS Issuer ID]_[Name of Accrediting entity], for example, “12345_NCQA.pdf.”

Application Resources