Health Plans/Managed Care Accreditation
About the Program:
AAAHC has been surveying and accrediting managed care organizations since 1983. In 2012, our Standards were significantly revised to reflect changes in the health care environment with a focus on managed care principles. Standards include:
- Member Rights, Responsibilities, and Protections
- Governance and Administration
- Provider Network Credentialing
- Case Management and Care Coordination
- Quality Improvement and Management
- Clinical Records and Health Information
- Environment of Care and Safety
- Health Education and Wellness Promotion
We have also added a new process for collecting outcomes data on your members and special accreditation programs for health plans that focus on Dental or Behavioral Health.
AAAHC has received Medicare Advantage Deemed Status from the Centers for Medicare and Medicaid Services. Additional information on Medicare Advantage Deemed Status accreditation can be found under the Medicare Advantage section of this page.
Resources:
Begin with the 2013 release of the Accreditation Handbook for Health Plans. The Handbook details the Standards and includes information on policies and procedures, as well as worksheets, tools and resources to help organizations prepare for their survey.
Downloads are:
Apply for a Health Plan Survey
Use the Application for Survey to submit all application materials to the AAAHC. If you have questions, please contact an Application Coordinator at info@aaahc.org or 847-853-6060
Online Application
NOTE: Organizations downloading the Application for Survey must also download the Business Associate Agreement for HIPAA compliance purposes.
Download Business Associate Agreement
The Centers for Medicare and Medicaid Services (CMS) has established a program that allows private, national accrediting organizations the opportunity to ensure that Medicare Advantage plans are complaint with the requirements of the Medicare Advantage program. CMS identifies those accrediting organizations as “deemed” entities. On June 28, 2002 CMS announced the approval of the Accreditation Association as a deemed entity, thereby allowing the Accreditation Association the privilege to survey Medicare Advantage HMO and PPO plans.
The six areas which are under the Medicare Advantage deeming authority for the Accreditation Association are: quality assurance, antidiscrimination, access to services, confidentiality and accuracy of enrollee records, information on advance directives, and provider participation rules.
A managed care organization that participates in the Medicare Advantage program may choose to have its AAAHC survey include a review of the Medicare Advantage requirements. Managed care organizations that request such a survey, should obtain the AAAHC Medicare Advantage Supplemental Guidebook. This guidebook contains the additional Medicare Advantage requirements that will be reviewed for compliance by the Accreditation Association surveyors.
To obtain a copy of the Medicare Advantage Supplemental Guidebook, as well as further details regarding the Medicare Advantage survey process, please contact Carolyn Kurtz at 847.853.6060.