ARSD 20:06:56:12. Accreditation

A qualified health plan must be accredited in the following categories by an accrediting entity recognized by HHS prior to certification: (1) Clinical quality measures, such as the healthcare effectiveness Data and Information Set; (2) Patient experience ratings on a standardized Consumer Assessment of Healthcare Providers and Systems survey; (3) Consumer access; (4) Utilization management; (5) Quality assurance; (6) Provider credentialing; (7) Complaints and appeals; (8) Network adequacy and access; and (9) Patient information programs.