Guidelines for agreements signed between CCIIO and the issuer to offer qHPs on the FFE and FF-SHOP markets. b) the specifications of the delegation agreement. Where one of the activities or obligations of the QHP issuer referred to in paragraph (a) of this section is delegated to other parties, the PQ issuer`s agreement with a delegated or downstream entity contains the specifications described in paragraph (b) of this section by January 1, 2015 for existing agreements; by the time the agreement on the agreement reached on October 1, 2013 comes into force. 4. Specify that the delegated or downstream agency, with respect to their right, books, contracts, computers or other electronic systems of the delegated or downstream company, the secretary and the OIG or their agent: to allow access to the books, contracts, computers or other electronic systems of the mandated or downstream company, including medical records and documents relating to the obligations of the QHQ issuer under the federal standards covered by point (a) of this section, up to ten years from the end of the agreement; and downstream unit: any party, including an agent or broker, that enters into an agreement with a delegated company or other downstream company for the provision of administrative or health care services as part of the agreement between the delegated entity and the QHP issuer. The term “downstream unit” refers to the company that directly provides administrative or health care services to qualified individuals, skilled employers or skilled workers and their members (45 CFR 156.20). UPMC ISD sends a notification to each DDE to communicate the closing time of the annual certificate. All DDEs must complete the certificates within the allotted time. The websites used to conduct the required screening are: QHP Certification Agreements for the Planned Year (PY) 2021: (1) Indicate delegated activities and reporting obligations; (3) The standards on page 155.220 of this sub-chapter with respect to attendance at registration in the PQ; and UPMC ISD issues qualified health plans (QHPs) via the federally Facilitated Marketplace, also known as the Exchange, which customers can access via the UPMC Health Plan Marketplace/Exchange website or the Healthcare.gov website.
The Centers for Medicare and Medicaid Services (CMS) require QHP issuers to oversee the activities of third parties, who perform administrative functions for the QHP issuer or who provide health care to beneficiaries, also known as “delegated and downstream companies” (DDEs). (2) The processes, procedures and trading standards covered by Part 155, Part 155 and, in the small group market, Sections 155.705 and 155.706 of this sub-chapter; (4) Standards for Articles 156.705 and 156.715 for the holding of data sets and compliance reviews for QHP issuers operating in a Federally-backed exchange or FF-SHOP. CMS does not return the Senior Officer Acknowledgement. (a) general requirement. Effective October 1, 2013, regardless of any relationship a QHP issuer may have with delegated and downstream companies, a QHP issuer retains responsibility for its compliance and compliance with all applicable or downstream companies, including – As part of the PQ certification process, the issuer must complete the confirmation of the plan to transmit CMS decisions.