NCQA Pushes for Clarity in HIX Proposed Rules

Cheryl Clark, for HealthLeaders Media , October 3, 2011

Thomas said that it's important for states to offer printed materials for health plan comparisons within their exchanges, in addition to what might be posted on a website. That's because in places like some rural areas of Mississippi, they don't have broadband. And, "you're going to need people on the ground to help consumers sort through choices, and for areas where people may not have a high level" of health literacy, and may not understand a term like "deductible."

Additionally, websites and printed materials as well as personnel to guide consumers through their selection process should be in multiple languages and dialects to reflect regional variation.

In its letter to CMS, the NCQA recommends that each state be required to evaluate qualified health plans based on a core set of quality measures that tightly specify procedure and diagnosis code level.

The NCQA has developed the well-known HEDIS measures, Healthcare Effectiveness Data and Information Set, and that set or other accredited sets should be applied across all exchange choices.

The NCQA also recommends that:

  • Exchanges use information that is collected annually beginning in June 2015 on 2014 exchange enrollees.
  • Exchanges be independently audited to ensure accuracy and comparability of results.
  • Include measures relevant and prevalent to the exchange population and already in use under public and privately sponsored healthcare coverage arrangements.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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