ACA Quality Assurance & Compliance 2

Question 1

Which federal agency is primarily responsible for overseeing ACA quality reporting requirements for health insurers?

Accepted Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

CMS oversees ACA quality reporting standards and compliance requirements for health insurers in the individual and small group markets.

Question 2

Under ACA Section 1001, what percentage of premium revenue must large group insurers spend on clinical care and quality improvement (MLR standard)?

Accepted Answer

85%

Answer

The ACA requires large group market insurers to spend at least 85% of premium revenues on clinical care and quality improvement activities.

Question 3

What is the purpose of the ACA's quality improvement strategy requirement for qualified health plans (QHPs)?

Accepted Answer

To ensure plans implement activities that improve health outcomes and patient safety

Answer

QHP quality improvement strategies must address clinical quality, patient safety, health outcomes, and reducing health disparities.

Question 4

Which ACA provision requires hospitals to report on a set of quality measures to avoid a payment penalty?

Accepted Answer

Hospital Value-Based Purchasing Program

Answer

The Hospital Value-Based Purchasing Program links Medicare payments to quality performance on clinical, patient experience, and safety measures.

Question 5

Under the ACA, which type of accreditation can substitute for CMS certification reviews for QHPs in the Federally Facilitated Marketplace?

Accepted Answer

NCQA, URAC, or AAAHC accreditation

Answer

CMS recognizes accreditation from NCQA, URAC, and AAAHC as meeting certain quality review requirements for QHP certification.

(ACA) Affordable Care Act Certified Practice Test